Brachytherapy in the Treatment of Localised Prostate Cancer โ€“ A Review of Minimally Invasive Treatment

Thierry A Flam
European Urological Review, 2011;6(2):74-83
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Abstract

Among the radiotherapy treatments for prostate cancer (PCa), ultrasound-guided low-dose-rate (LDR) transperineal brachytherapy is an option that is capable of delivering highly concentrated doses of radiation to the prostate gland. This technique involves the precise insertion of seeds containing a radioisotope into the prostate gland to apply radiation doses to the tumour while sparing the surrounding healthy tissue. LDR brachytherapy is a safe and efficient technique that is typically applied to patients with low-risk PCa. It has become a mainstream treatment option for a wider population of men diagnosed with PCa, due to the excellent long-term treatment outcomes that have been seen in low- and intermediate-risk patients. The use of LDR brachytherapy is now increasing due to its reliability, reproducibility and the increasing number of tumours being detected at the early stage of localised PCa. Newer surgical techniques in PCa have not improved clinical outcomes and this has contributed to the consideration of brachytherapy, which is a truly minimally invasive technique with excellent clinical outcomes.

Support: The publication of this article was funded by Eckert & Ziegler BEBIG. The views and opinions expressed are those of the author and not necessarily those of Eckert & Ziegler BEBIG.
Keywords
Brachytherapy, low dose rate, prostate cancer, quality of life, radiation therapy, seeds, iodine-125
Disclosure The author has no conflicts of interest to declare.
Received: July 25, 2011 Accepted November 22, 2011
Correspondence: Thierry A Flam, Department of Urology, Hรดpital Cochin, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France. E: thierry.flam@cch.aphp.fr

Prostate cancer (PCa) is recognised as one of the major medical problems facing the male population, with a higher incidence among Europeans and populations of European origin compared with other world regions such as Africa and Asia. Within Europe, studies for the years up to 2005 report the incidence of PCa to vary from 10โ€“15 cases/year/100,000 of the population in Serbia to 90โ€“95 cases/100,000 in Sweden, compared with 0โ€“5 reported cases/year/100,000 in Northern Africa and China.1,2 Across other countries in Europe the incidence of PCa also varies; in Spain it has been reported to be in the range 35โ€“39.9 cases/year/100,000, compared with 50โ€“54.9 in the UK, 55โ€“59.9 in France and 60โ€“64.9 in Germany.2 Mortality in PCa is declining at different rates; across Western Europe this is occurring at -0.8 % to -3.1 %/year, but in Eastern Europe it is increasing at rates of 3โ€“9.6 %/year.1โ€“3 According to Cancer Research UK, PCa constitutes approximately 24 % of all male cancers4 resulting in 12 % of all male cancer-related deaths in the UK.5 There are currently a range of treatment options, among which radiotherapy and radical prostatectomy (RP) are the standard approaches. If treated appropriately, patients with localised PCa have a good chance of being disease-free for at least 15 years.6

The current management of localised PCa relies upon four main options: RP, external-beam radiation therapy (EBRT), brachytherapy (BT) and active surveillance (AS). The limited number of randomised controlled comparative clinical trials is reflected in an absence of level 1 clinical evidence for any of these options. Consequently, treatment choice tends to be based on physician experience or patient preference and the perception of potential side effects.

Some urologists consider RP to be the standard option for the treatment of patients with localised cancer and a life expectancy greater than 10 years. However, this procedure carries a significant risk of side effects, including erectile dysfunction, urinary incontinence and surgical complications. The likelihood and impact of these side effects has led to an increasing interest in alternative treatments with potential for decreased morbidity and equivalent disease-free survival. Robot-assisted RP has recently become a predominant surgical method. This treatment, however, has not significantly improved cancer outcome, continence, erectile function preservation and patient satisfaction, compared with traditional surgical techniques for prostatectomy.7โ€“9

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Brachytherapy in the Treatment of Localised Prostate Cancer โ€“ A Review of Minimally Invasive Treatment

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