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Updates in Brachytherapy

Peter J. Rossi, MD, a radiation oncologist affiliated with Kaiser Permanente and Valley View Hospital in Glenwood Springs, Colorado, discusses the benefits of brachytherapy for patients with intermediate-risk prostate cancer, arguing that it should be in wider use in the United States than it currently is. He notes that there is a lot of level I evidence for brachytherapy’s effectiveness, and that low dose rate brachytherapy plus external beam radiation therapy (EBRT) plus androgen deprivation therapy (ADT) is far more effective after several years than EBRT plus ADT alone, as is EBRT plus a high dose rate brachytherapy boost. This difference has largely been ignored in the US because of a slightly higher toxicity rate with brachytherapy, but Dr. Rossi argues that the treatment has improved over time, especially with the introduction of MRI-based brachytherapy. Dr. Rossi concludes by noting that there needs to be better messaging around brachytherapy, as well as greater efforts to train new brachytherapists.