Treatment of Prostate Cancer: Brian J. Moran Distinguished Lecture: Prostate Brachytherapy

Prostate brachytherapy has produced durable long-term outcomes across multiple prostate cancer risk groups. In the Brian J. Moran Distinguished Lecture at the 36th Annual International Prostate Cancer Update, Grgur Mirić, MD, FACR, FABS, Director of the Schiffler Cancer Center, Men’s Health Center, and Cryosurgery Services, Wheeling Hospital, and Associate Professor of Radiation Oncology, Wheeling Jesuit University, Wheeling, West Virginia, reviews evidence supporting brachytherapy and discusses why long-term survivorship care must be integrated into prostate cancer management. Dr. Mirić describes how low-dose-rate brachytherapy monotherapy has demonstrated durable biochemical control in both prospective trials and large multi-institutional analyses. Early randomized trials comparing palladium-103 and iodine-125 isotopes helped establish the importance of implant quality and delivered dose in achieving optimal outcomes. He reviews alternative radiation strategies, including high-dose-rate (HDR) brachytherapy and stereotactic body radiation therapy. Multi-fraction HDR regimens appear to provide better outcomes than single-fraction approaches, though they may require multiple procedures. For intermediate-risk prostate cancer, randomized trials suggest that high-quality brachytherapy monotherapy can achieve excellent long-term outcomes without the need for supplemental external beam radiation. In higher-risk disease, studies such as ASCENDE-RT demonstrate that brachytherapy boost strategies may significantly reduce biochemical failure compared with external beam radiation alone. Despite these advances, Dr. Mirić emphasizes that many prostate cancer survivors ultimately die from causes unrelated to prostate cancer. He highlights the importance of cardiovascular risk assessment, lifestyle interventions, and comprehensive survivorship care to improve long-term outcomes for men treated for prostate cancer. Don't forget to join the GRU Community: https://grandroundsinurology.com/regi... Follow us on Twitter/X: https://x.com/GRUrology And like and subscribe to us here on YouTube!