How to cite: Song DY. Focal brachytherapy for prostate cancer. September 16, 2025. Accessed January 2026. https://grandroundsinurology.com/focal-brachytherapy-for-prostate-cancer-3/
Summary
Daniel Y. Song, MD, Professor of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland, summarizes the clinical rationale, emerging evidence, and trial design considerations relevant to integrating focal brachytherapy into practice. Dr. Song positions focal brachytherapy as a targeted approach that may offer oncologic control with reduced treatment-related toxicity in selected men with prostate cancer.
Dr. Song focuses on the index lesion concept, where the dominant intraprostatic tumor often drives progression. Pathology and imaging data suggest that metastases usually arise from the index lesion, and recurrence after radiotherapy tends to occur in the same location as the primary tumor.
Brachytherapy has decades of data in prostate cancer with high control rates and favorable safety, making it a strong candidate for focal adaptation. Dr. Song reviews French pilot studies that demonstrated acceptable urinary and sexual function after focal brachytherapy, as well as registry data showing durable failure-free survival. He also describes an ongoing Johns Hopkins trial that combines multiparametric magnetic resonance imaging and prostate-specific membrane antigen positron emission tomography for treatment planning, utilizing an in-house real-time dosimetry platform. Trial design includes a confirmatory biopsy at two years.
Dr. Song argues that biological rationale, preliminary data, and feasibility studies support the use of focal brachytherapy. Key considerations remain patient selection, imaging accuracy, and confirmation of durable cancer control in prospective trials. Focal brachytherapy may complement the evolving paradigm of focal therapy in prostate cancer.
The Global Summit on Precision Diagnosis and Treatment of Prostate Cancer is a unique multi-disciplinary forum organized to inform the key health care stakeholders about the emerging advances in clinical case and research and create a consensus-based vision for the future of precision care and educational and research strategy for its realization. The mission of the Summit is to fill the currently existing gap between the key experts of in vivo imaging, the world authorities in the in vitro fluid- and tissue-based molecular diagnostics, including genomics, and thought leaders in the development of novel observation strategies (e.g., active surveillance, or AS) and therapeutic interventions.
ABOUT THE AUTHOR
Dr. Daniel (Danny) Song is a Professor of Radiation Oncology, with joint appointments in Urology and Oncology. He serves as the Co-director of the Prostate Cancer Multidisciplinary Clinic at the Johns Hopkins Hospital and the Physician Advisor and Director of Faculty Affairs for the Department of Radiation Oncology and Molecular Radiation Sciences. His area of clinical expertise is in the management of genitourinary cancers, including cancers of the prostate, bladder and urinary tract, and testicular cancer.
