Focal low-dose-rate (LDR) brachytherapy

Focal brachytherapy means placing radioactive seeds in part of the prostate rather than the whole gland. Radiation oncologists plan dose to the MRI-defined tumour plus a margin while trying to spare urethra and rectum compared with whole-gland plans.

Planning

Modern focal seed plans fuse MRI with ultrasound or use in-bore MRI techniques at some centres. Pathology grade, percent core involvement, multiparametric MRI score and distance from urethra influence whether partial-gland dose is considered safe.

Outcomes and trade-offs

Published series report intermediate oncological outcomes and quality-of-life metrics compared with whole-gland LDR and with other focal modalities. Retreatment with seeds, external beam or surgery may be technically more complex after any brachytherapy.

Multidisciplinary input

Urology and radiation oncology jointly counsel most men. Medical oncology may join for higher-risk presentations. Confirm who leads follow-up PSA testing, imaging and biopsy protocols.

Medicare item numbers and public hospital access for focal seed plans vary. Ask the rooms or radiation oncology department for current pathways.
References
  1. Peters M, van der Voort van Zyp JR, Moerland MA, et al. - Focal LDR brachytherapy: a pilot study of a novel treatment for low- and intermediate-risk prostate cancer. Radiother Oncol. 2015 Oct;117(1):83-88 - doi: 10.1016/j.radonc.2015.08.016
  2. John R Heard, Aurash Naser-Tavakolian, Michael Nazmifar - Focal prostate cancer therapy in the era of multiparametric MRI: a review of options and outcomes - Prostate Cancer Prostatic Dis. 2023 Jun;26(2):218-227 - DOI: 10.1038/s41391-022-00501-0
  3. Zamboglou N, Thilo C, Drendel V, et al. - MRI versus CT-based high dose rate interstitial brachytherapy for prostate cancer: results of a prospective randomized trial. Radiother Oncol. 2018 Aug;128(2):283-289 - doi: 10.1016/j.radonc.2018.06.012 (MRI guidance context)

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