Results

Results

Outcomes for Seed Brachytherapy.

Comparison show that the long-term cure rates from all modern prostate cancer therapies is equal [1].

One treatment does not offer any cure advantage over the other. Seed brachytherapy offers equivalent outcomes to that of surgery, including robotic surgery.

Multiple international, high-level, evidence-based treatment guidelines attest to this [2],[3],[4],[5].

We are the most experienced seed treatment centre in Australia and have done nearly a thousand implants since we started in 1998.

Figure 1 shows the disease-control for all the men we have treated, including both “low-” and “intermediate-risk” men, are included here. The rate is 90.2% (shown as a proportion 0.902 on the graph).

 

Figure 1.

The cancer control for “low-risk” men is better than 92% at 10 years (not shown here).

It therefore comes down to what options are suitable for you and what treatment offers the lowest risk of toxicities, important to you. Below are some of the common risks and differences between surgery and brachytherapy.

Obviously it is important to discuss all the risks with the appropriate specialist.

Perioperative Death

This doesn’t happen after seed brachytherapy: patients usually go home the same day as the implant. After radical prostatectomy in large series the mortality rate has been reported as between one in a hundred or one in two hundred [6],[7].

In one study in men 80 or older one in twenty-five was dead with thirty days of the surgery [6].

Urinary bother and irritation

This is the most common troublesome side effect of seed brachytherapy. Often men will have bladder irritation initially for 1 – 2 months. However this is likely to settle. The vast majority of men have returned to their normal urinary function by one year.

Less than 5% will have ongoing, “permanent” urinary problems. Significant problems requiring intervention or a catheter are very rare.

Incontinence

No matter how clever the surgeon, or advanced the technology, the stats show that around 5%-10% of men having a radical prostatectomy will have serious incontinence [8].

With seed brachytherapy serious incontinence is a rare event seen in <1% of patients [9], [10].

Impotence

It is widely know that radical prostatectomy will practically always cause complete failure to have useful erections. These very uncommonly get back to the prior function, even with the new nerve-sparing procedures. Seed brachytherapy patients usually do not have the problems with their erections.

A recent large American study illustrates this [11]. They looked at over a 1000 men treated with either surgery or brachytherapy and were able to derive a very accurate predictive model that allowed estimation of the chances of “functional erections” in men after nerve-sparing surgery, non-nerve-sparing surgery, or seed brachytherapy, depending on their erectile function before hand (Figure 2).

Figure 2. Alemozaffar M, et al. Prediction of Erectile Function following Treatment for Prostate Cancer. 2011 JAMA 306; 11:1209.

This showed that if men had “100%” erections prior to treatment, at two years after brachytherapy 92% were OK, whereas after standard surgery this was not much better than 25%.

Following surgery, some men notice “penile shrinkage” and this can be a concern to patients and their partners. This is not seen following seed brachytherapy.

Bowel problems

Men often note a minor change in bowel habit after brachytherapy, but not enough to bother them. Sometimes there is a small amount of bleeding, but this usually settles spontaneously. The risk of bowel damage is very unlikely in the long term.

Surgery does not usually cause bowel damage.

Outcomes for Seed Brachytherapy

References

[1] Kupelian et al. Radical prostatectomy, external beam radiotherapy &lt;72 Gy, external beam radiotherapy ≥72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1–T2 prostate cancer, IJROBP, 58(1) 2004, Pages 25-33

[2] Australian National Health and Medical Research Council “The panel at this time considers these interventions to be options for the treatment of localised prostate cancer because the data currently available in the literature do not provide sufficient clear-cut evidence to indicate the unquestioned superiority of any one form of treatment.” Australian Cancer Network Working Party on Management of Localised Prostate Cancer. Clinical Practice Guidelines: Evidence-based information and recommendations for the management of localised prostate cancer. NHMRC 2002

[3] European Society of Medical Oncology. “Options include active surveillance, radical prostatectomy, external beam radiotherapy, brachytherapy with permanent implants or high dose rate brachytherapy with temporary implants… Ten-year prostate cancer specific survival approaches 100% for each management option”.Horwich A, Parker C, et al Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology 2010.

[4] Australian Prostate Cancer Collaboration “It is not known which type of treatment is the best for localised prostate cancer. Therefore… it is important to think about the quality of your life after you have had treatment.” Localised prostate cancer. A guide for men and their families. 2006

[5] American Urological Association “interstitial prostate brachytherapy, external beam radiotherapy, and radical prostatectomy are appropriate monotherapy treatment options for the patient with low-risk localized prostate cancer. Thompson I, Aus G, Burnett AL, et al “Guideline for the Management of Clinically Localized Prostate Cancer: 2007 Update” AUA 2007

[6] Bubolz T, Wasson JH, Lu-Yao G, et al. Treatments for prostate cancer in older men: 1984–1997. Urology 2001; 58(6):977–82.

[7] Lu-Yao GL, McLerran D, Wasson J, et al. An assessment of radical prostatectomy. Time trends, geographic variation, and outcomes. The Prostate Patient Outcomes Research Team. JAMA 1993 May 26; 269(20):2633–6

[8] Stanford et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study.JAMA 2000; 283:354.

[9] Crook, J., Fleshner, N., Roberts, C., & Pond, G. (2008). Long-Term Urinary Sequelae Following 125Iodine Prostate Brachytherapy. The Journal of Urology, 179(1), 141–146.

[10] Peinemann, F., Grouven, U., Bartel, C., Sauerland, S., Borchers, H., Pinkawa, M., Heidenreich, A., et al. (2011). Permanent Interstitial Low-Dose-Rate Brachytherapy for Patients with Localised Prostate Cancer: A Systematic Review of Randomised and Nonrandomised Controlled Clinical Trials. European Urology, 60(5), 881–893.

[11] Alemozaffar M, et al. Prediction of Erectile Function following Treatment for Prostate Cancer. 2011 JAMA 306; 11:1209.

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