Dear OncoLink "Ask The Experts,"
Does the size of the prostate (e.g. greater than 90cc) automatically preclude brachytherapy?
Neha Vapiwala , MD, Senior Editor of OncoLink and Chief Resident in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania, responds:
No, a large prostate does not automatically preclude brachytherapy as a treatment option. However, a patient with a large prostate may be asked to undergo a temporary course of medication (drugs such as Zoladex or Lupron) in order to reduce the prostate to a size more optimal for performing brachytherapy.
In most cases, this approach works, and the ideal brachytherapy volume is successfully achieved. Also, some centers are studying and using combination external beam radiation therapy and brachytherapy for large and/or more advanced stage prostate cancers.
Having said this, many practitioners believe that the ideal prostate volume for immediate brachytherapy would be 40-50 cc or less. There are three reasons for this view: