ABSTRACT
Extraprostatic extension (EPE) is an unfavorable prognostic factor for prostate cancer patients with clinically organconfined disease. Growing evidence suggests that EPE may exist in a significant fraction of favorable risk clinical stage T1-T2 patients, with numbers reported between 10% and 50%.1,2 The extent of EPE has been the topic of several recent studies, with potential implications for prostate brachytherapy.3-5 The goal of brachytherapy is to deliver a uniform dose with an adequate margin for disease eradication. However, the steep dose gradient at the periphery of the prostate (up to 20 Gy/mm) brings into question the dose actually being delivered to potential EPE.6 As a result, the American Brachytherapy Society (ABS) currently recommends that patients with a high risk for EPE be treated with external beam radiotherapy (EBRT) with brachytherapy used as a boost.7
