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To the Editor: The study by Dr D'Amico and colleagues¹ suggests that although radical prostatectomy, external radiotherapy, and brachytherapy are efficacious against low-risk prostate cancer, brachytherapy is less effective than the other methods against intermediate- and high-risk cases. However, several aspects in this study, including the therapeutic approach, implantation adequacy, and technical factors, require examination.

First, intermediate- to high-risk patients, as defined in this study, had a 28% to 97% risk of having cancer cells beyond the prostate.² As brachytherapy could undertreat cancer cells beyond the prostate, practitioners usually combine brachytherapy with external beam radiation in these cases. D'Amico et al give the potentially misleading impression that practitioners use brachytherapy alone against intermediate- to high-risk lesions, which does not reflect the standard practice for these patients.

Second, this study could include the first ultrasound-guided prostate brachytherapy cases ever performed at the reporting institution, whereas external radiotherapy and radical prostatectomy are . . . [Full Text of this Article]