Brachytherapy: IQWIG report contradicts scientific standards

LDL brachytherapy (seed implantation) has been an established treatment option for localized prostate cancer in national and international guidelines of medical societies for more than 20 years. However, despite the clear evidence, the Institute for Quality and Efficiency in Health Care (IQWiG) has repeatedly investigated the significance of the method on behalf of the Joint Federal Committee (G-BA). In a recent report dated 16 November 2018, the Institute again came to the conclusion that "due to a lack of meaningful data, it must remain unclear whether or not interstitial brachytherapy offers advantages over other methods for men with locally confined prostate cancer". 

The results of the current report were based on two new studies, only a fraction of the scientific work published in recent years. The reason: All studies that evaluated the clinical course of brachytherapy on the basis of PSA-free survival were excluded. The PSA value as a parameter for tumor control and thus for the success of a therapy is standard in the scientific literature. This applies to studies on brachytherapy, prostatectomy as well as external radiation therapy.

Unscientific evaluation

IQWIG thus not only ignores recognized methods of scientific research, but also prevents patients with localized prostate cancer from receiving highly effective therapy with few side effects. The advantages of LDL brachytherapy with regard to continence and erectile function are obvious and could not even be discussed away by IQWIG. However, the better data on quality of life were not taken into account in the assessment, as IQWIG found that there was no direct prospective comparative study. 

Millions lost through PREFERE study 

However, the PREFERE study commissioned by the G-BA has clearly shown that this is not feasible, as the effectiveness, side effects and influence on the quality of life of the various treatment strategies in localized prostate cancer should be clinically tested against each other. Why, instead, prospectively comparative cohort studies are not included in IQWIG's assessment must therefore be politically desired, since there is no scientific explanation for this. 

Sad conclusion: The recent misjudgement of LDL brachytherapy inevitably leads to a situation in which patients with localised prostate cancer in Germany will not be treated as specifically and well as they would be treated according to international standards. Once again, radical prostatectomy will be protected and complications and loss of quality of life will be accepted. 

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