Manuj Agarwal, MD, on patient selection for prostate brachytherapy

Prostate brachytherapy can be used across a broad range of patients with prostate cancer, according to Manuj Agarwal, MD. In a recent interview with Urology Times®, Agarwal broke down the clinical scenarios where brachytherapy can be considered a treatment option.

Specifically, he explained that brachytherapy can be used as a monotherapy for lower-risk patients, a boost in higher-risk cases, a salvage option after recurrence, and even as a focal therapy in well-selected individuals.

Agarwal is a radiation oncologist and the co-founder of Prostate Cancer Institute of America.

Agarwal began by discussing the low-risk or favorable intermediate-risk patients, saying, “For some men, this is a great treatment option, because they are getting their prostate cancer treated in under an hour, sometimes even 30 minutes. They go home and have minimal side effects. So, for the man who's looking for an efficient, low toxicity treatment, it's a good option.

He then discussed the use of brachytherapy in the boost setting, where the treatment modality can be used in combination with other therapies. While this is ideal for patients with unfavorable intermediate-risk disease or higher, Agarwal noted that some unfavorable intermediate-risk patients may still receive monotherapy.

“The way I like to think about it is if there's any patient that urologists typically feel very comfortable operating on, brachytherapy can be a near equivalent local solution,” he explained.

Brachytherapy may also be considered in the salvage setting or as a focal option, Agarwal added.