Prostate Brachytherapy: The Unsung Hero

Posted on: January 10th, 2015

Apparently the United Kingdom is similar to the US in having Prostate Brachytherapy underutilized in the fight against prostate cancer. In this article from the Darlington& Stockton times in England prostate brachytherapy is characterized as the” unsung hero” among prostate cancer treatments and we have to wholeheartedly agree. Although Brachytherapy has a cure rate equal or better than surgery, urologists (surgeons) many times do not present it as an option to their patients although it can put them back to work the next day, save them from side effects of incontinence and impotence and save the insurance company or the patient thousands of dollars in costs.

There are 3 myths that we have identified here at Chicago Prostate Center:

1. Many urologists tell patients that they are too young to have surgery.

Fact: Published data has demonstrated brachytherapy to be an excellent and equal treatment option for younger patients. There is no scientific data to suggest younger patients have better cure rates with surgery. This has long been a misconception on the part of some physicians. In fact, there are numerous studies that show that there are no differences in cure rates with young patients (age 62 or less) versus older patients1-2,4. All treatment options should be offered to patients. A recent study concluded that of patients with prostate cancer treated with a monotherapeutic approach, better urinary continence was exhibited in those who underwent radiation-based therapies. Furthermore, higher sexual function scores were seen in men who selected brachytherapy3.

2. Surgery can not take place after brachytherapy.

Fact: This is not true, and in the rare cases when surgery is needed after brachytherapy, it can be done successfully. However, it is important to keep in mind that having a local recurrence (when the cancer comes back in the prostate) is very rare; if prostate cancer treatment fails, it is usually metastatic (spreads outside the prostate). In such a situation, removing the prostate is of no value.

3. With surgery, an individual with prostate cancer will be 100 percent cured.

Fact: Cure rates for early stage prostate cancer have been proven equal for brachytherapy, surgery and external beam radiation. For a low risk patient, cure rates average 95% for all three treatments. Sharkey et al found that for low risk patients, brachytherapy resulted in 99% cure rates, while surgery resulted in cure rates of 97%4. After radical prostatectomy, pathologically advanced disease is detected in 38% to 52% of patients5. Therefore, although cure rates are excellent for many different treatment options, it is a myth that surgical removal results in 100% cure.