ESTRO: Brachytherapy achieves excellent results

Internal radiation – more effective, safer, and cost effective than radical surgery

 

Urinary incontinence, erectile dysfunction, impotence?

Especially for younger patients with prostate cancer, the expected adverse effects play a crucial role in the selection of a therapy. Brachytherapy, a special form of "internal" radiation has not only proven to be highly effective, but also has proven to have fewer side effects. A recent study, which was presented at the annual meeting of the European Society of Radiology and Oncology (ESTRO), clearly demonstrates: patients, who are treated with brachytherapy instead of traditional surgery, can expect a much better quality of life after surgery, without having to compromise healing. Moreover, the brachytherapy is in comparison to the radical removal of the prostate much more cost effective.

Whether surgery, brachytherapy, or external irradiation - the cure rates for patients with the cancer limited to the prostate, are with 90% very regardless of the type of treatment. "Once the decision for a therapy is made, the primary concern should be on selecting the less invasive and most gentle procedure," said Dr. Neubauer from the West German Prostate Center in Cologne. Nevertheless, unfortunately the reality, at least in Germany, is still different, criticized the urologist. Invasive surgery is still number one on the list of conducted therapies for localized prostate cancer. And, this regardless of significant side effects, such as erectile problems, lack of sex or urinary incontinence. One in five patients also confirmed surgery-related complications, such as severe bleeding or bowel injury.

 

Best results for brachytherapy

Increasingly more studies proof that brachytherapy has the the highest score with regard to the quality of life and patient satisfaction. In this ultra-modern form of radiation therapy, the tumor in the prostate is destroyed with utmost precision from within and neighboring organs such as bowel, bladder, and urethra are protected. The superiority of brachytherapy compared to the radical prostatectomy  was again evidenced by a systematic analysis encompassing data of 55.000 patients. This study was just recently presented at the annual meeting of the European Society of Radiology and Oncology1.

Analyzed was the healing rate, health-related criteria for quality of life, and cost of treatment over a period of 10 years. The results were clear: Both the seed implantation in patients with a low risk as well as the HDR afterloading in combination with external radiotherapy in prostate cancer at a more advanced stage were in comparison to the surgical removal of the prostate associated with a significantly higher quality of life.

 

Lower costs for  brachytherapy

Another advantage is that brachytherapy is the most cost-effective option in the treatment of localized prostate cancer. Not only are long recovery times after surgical removal especially costly to the patient, but also for employers and health insurers. The patient is at a minimum 104 days on sick leave after a radical prostatectomy, while a patient following brachytherapy, can resume work as early as the day following the treatment. The costs are extremely high since time-consuming treatment-related complications and side effects of surgery, such as total urinary incontinence and impotence, have to be added in.

"The goal of the treatment for patients with a tumor limited to the prostate should always be to achieve a cure and to prevent the disease from degrading the quality of life," says Dr. Neubauer. "Here the United States is already a big step ahead of us," says the urologist of the West German Prostate Center.  While in Germany only 8 percent of all  patients are treated with brachytherapy, in the US 25% of the men with prostate cancer already benefit from this less invasive therapy.

 

Literature.

1 Steuten LMG. Comparative cost / QALY of guideline-recommended treatments prostate cancer: a UK cost perspective. PD 0371; 2nd ESTRO Forum, Geneva, Switzerland, 2013.