Pryndiuk S. I., Artiukh S. V.

BRACHYTHERAPY FOR LOCALIZED PROSTATE CANCER: THE CONTEMPORARY ROLE OF LDR AND HDR APPROACHES

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About the author:

Pryndiuk S. I., Artiukh S. V.

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LITERATURE REVIEWS

Type of article:

Scientific article

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Prostate cancer remains one of the most common malignancies in men. Brachytherapy delivers a high dose directly to the prostate with a steep dose fall-off beyond the target volume, allowing intensive local dose escalation with relatively low exposure of adjacent structures. Two approaches are used in contemporary practice: low-dose-rate brachytherapy with permanent implantation of 125I or 103Pd sources, and high-dose-rate brachytherapy with temporary insertion of an 192Ir source through catheters. The available evidence is heterogeneous, comprising randomized trials of a brachytherapy boost, large single-institution series, registry analyses and a limited number of comparative studies whose populations differ substantially in risk group composition, use of androgen deprivation therapy, prescribed doses, planning technique, definitions of biochemical failure and duration of follow-up. The aim of the study is to summarize current clinical evidence on low-dose-rate and high-dose-rate brachytherapy in localised prostate cancer, including oncological outcomes, toxicity profile, quality of life, the role of a brachytherapy boost and practical criteria for patient selection. A structured literature search was performed in PubMed/MEDLINE, Embase, Cochrane Library, Scopus and Web of Science from January 1990 to December 2025, without language restrictions. Randomized controlled trials, prospective and retrospective cohorts, large institutional series, systematic reviews and consensus guidelines were considered. Owing to substantial differences between studies in design, risk group composition, dose-fractionation regimens, use of androgen deprivation therapy, definitions of biochemical failure and toxicity scales, no quantitative meta-analysis was undertaken; numerical results are reported separately for each study together with population size, endpoint definition and the time point of assessment. Large low-dose-rate brachytherapy series demonstrate durable long-term biochemical control in appropriately selected patients with low- and favourable intermediate-risk disease. In unfavourable intermediate- and high-risk disease, the ASCENDE-RT randomized trial showed superior biochemical progression-free survival with a low-dose-rate boost compared with a dose-escalated external beam boost, at the cost of a threefold higher cumulative incidence of late grade 3 genitourinary toxicity and without an overall survival benefit. High-dose-rate brachytherapy has robust randomized evidence as a boost and promising monotherapy results in experienced centres; however, direct randomized comparisons sufficient to conclude equivalence between the two modalities are lacking. Baseline urinary function, prostate volume and anatomy, previous transurethral procedures, age, baseline erectile function and androgen deprivation therapy are the principal determinants of functional outcome. Brachytherapy remains an effective radical treatment for localised prostate cancer provided that patient selection and implant quality are adequate; the available evidence does not establish clinical equivalence between low-doserate and high-dose-rate approaches, and modality selection should therefore be individualized.

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Bibliography:

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Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 3, 182, 132-139 pages, index UDC 616.65-006.6-08:615.849

DOI:

10.29254/2077-4214-2026-3-182-132-139