Higher quality of life after brachytherapy

Latest results of the two-year SPIRIT study show clear advantages for brachytherapy

Higher quality of life, hardly any incontinence and better erectile function. The latest results of the SPIRIT study show clear advantages of brachytherapy over the radical removal of the prostate in patients with localized prostate cancer. Brachytherapy is also far superior to surgery in terms of patient satisfaction.

In patients with prostate carcinoma, brachytherapy, external radiation and surgery each lead to the same treatment rates, provided that the tumor is detected at an early stage. This has already been clearly demonstrated in numerous studies1. In contrast, data on quality of life in successfully treated patients are very rare. Dr. Pedram Derakhshani, a urologist at the West German Prostate Center, says:"When choosing the appropriate therapy, we have to consider not only the rate of healing but also the influence of the treatment on the quality of life of those affected.

Recently, a large-scale study2 has compared brachytherapy and surgical removal of the prostate gland with respect to their health-related quality of life using standardized questionnaires. Questions were asked about the functions of urinary bladder emptying (miktion) and continence, erectile function, intestinal dysfunction, effects of hormonal treatment and patient satisfaction. However, there were no differences between the two forms of therapy for intestinal and hormone-specific questions.

The results show that factors that are important for the quality of life after therapy are clearly more positive in brachytherapy than in radical surgery. For example, the study showed that brachytherapy affects sexuality less and leads less often to urinary incontinence than radical removal of the prostate.

The results are in line with the guidelines of the German Society of Urology (DGU),"explains Dr. Derakhshani. It states that prostate cancer patients receiving brachytherapy suffer significantly less often from impairment of their potency after treatment than patients receiving brachytherapy after surgery. Urinary incontinence, which is up to 50 percent after radical removal of the prostate, is also negligible at 0.3 to 3 percent after seed implantation and only occurs after prior removal of the prostate (TURP).

Literature:

Kupelian PA et. al.: Radical prostatectomy, external beam radiotherapy or =72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol Phys. 2004 Jan 1;58 (1): 25-33.
Crook JM et al. Comparision of health-related quality of life 5 years after SPIRIT: Surgical prostatectomy versus interstitial radiation intervention trail. J ClinOncol. 2011 Feb1;29 (4): 362-8. epub 2010 Dec 13.

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