Brachytherapy for prostate cancer: Present and future

Based on recent, important publications on the impact of brachytherapy in the management of prostate cancer, we analysed already validated indications and the “under investigations” use of brachytherapy. Published studies (MEDLINE), randomized trials and recommendations were reviewed, as well as Delphi consensus when available. While low-dose rate brachytherapy remains a standard of care for low-risk eligible patients, three randomized trials are now available to consider that combination of external beam radiation therapy with brachytherapy boost (low- or high-dose rate) appears as a recommended treatment for intermediate and high-risk patients. Other indications of prostate brachytherapy (monotherapy and salvage) remain under evaluation. For low-risk patients with good urinary status, low-dose rate brachytherapy alone should be offered. For low-intermediate risk prostate cancer, low-dose rate brachytherapy alone may be offered as monotherapy, while for high-intermediate risk prostate cancer, a combination of external beam radiation therapy (with or without androgen deprivation therapy) plus brachytherapy boost (low- or high-dose rate) should be offered to eligible patients. For patients with high-risk prostate cancer receiving external beam radiation therapy and androgen deprivation therapy, brachytherapy boost (low- or high-dose rate) should be offered to eligible patients. High-dose rate brachytherapy as monotherapy (single dose for low-risk/multifractionated for intermediate and high-risk) must be explored under clinical investigations, as well as salvage brachytherapy for local recurrence. Des publications récentes ont confirmé l’intérêt de la curiethérapie dans la prise en charge du cancer de la prostate. Nous proposons d’évaluer la place de la curiethérapie dans ses indications validées, mais également dans le cadre de protocoles de recherche clinique. Les données de la littérature (Medline), comme les essais randomisés, les recommandations de sociétés savantes ou des consensus basés sur la méthode Delphes ont été analysées. Alors que la curiethérapie de bas débit de dose reste un standard thérapeutique pour les patients éligibles atteints d’un cancer de la prostate de faible risque de rechute, les résultats de trois essais randomisés sont actuellement disponibles, permettant de considérer que l’association d’une radiothérapie externe et d’une curiethérapie de bas ou haut débit de dose apparaît comme un traitement recommandé pour les cancers de la