Irradiate prostate cancer instead of surgery

Nationwide patient survey documented: Highest patient satisfaction and best quality of life after radiotherapy.

Tuesday, March 31,9:30 a. m., Urology Department. The date at the Protestant hospital in his home town was already fixed. Then Lothar S. changed his mind at the last minute. The 62-year-old mechanical engineer was diagnosed with prostate cancer at the beginning of the year after a routine examination by his urologist. Luckily, the tumor was detected early on, even before it broke through the prostate capsule and could form metastases in other organs. His urologist advised him to completely remove the prostate gland. Lothar S. agreed without informing himself about further therapy options. Only an acquaintance who was confronted with the same diagnosis 5 years ago urged him to seek a second opinion.

Lothar S. is not an isolated case:"Often the surgical appointment has already been fixed without the patient being fully informed about the various therapy options," reports Dr. Pedram Derakhshani, urologist at the West German Prostate Center in Cologne. "Side effects such as incontinence and impotence are unreservedly accepted by many people affected." The numbers are still very high, despite the fact that surgery techniques that protect the nerves are still very high: for example, every 10th patient can no longer hold on to the urine after surgery, almost two thirds suffer from erectile dysfunction That the radical removal of the prostate gland is still regarded by many doctors as the only successful treatment option for prostate cancer is, according to Derakhshani, long since outdated. Numerous studies (1) have shown that patients whose tumor is limited to the prostate can achieve the same healing rates with surgery, brachytherapy (inner radiation) and external radiation.

Targeted weapon

Radiation treatment in particular has achieved great success in the treatment of prostate cancer in recent years thanks to rapid technological progress. We are now able to radiate a very high radiation dose into the tumour without damaging the adjacent healthy tissue,"explains Dr. Gregor Spira, radiotherapist at the West German Prostate Center. "For this purpose, sophisticated radiotherapeutic methods such as internal radiation (brachytherapy) are available." In contrast to "external" radiation, the smallest radiation sources are introduced directly into the prostate and destroy the tumor directly on site. A particularly innovative technique of brachythe-rapy is the so-called seed implantation. Mini implants are implanted into the prostate gland and deliver high-dose radiation to the tumor tissue in a targeted manner over a period of several months. Afterloading therapy is used to treat advanced stages or aggressive tumours. Special hollow needles are inserted into the prostate under ultrasound control. According to an exact, computer-aided radiation planning by the radiotherapist, a highly active radiation source, in contrast to seed implantation, only temporarily moves into the implanted needles and illuminates the tumor with a high radiation dose.

Current study: 93 percent very satisfied with brachytherapy

Brachytherapy has a major advantage over surgery:"When removing the prostate, the surgeon always leaves a sharp cutting edge. Occasionally, however, individual malignant cells may still be present beyond this selected boundary. With radiation therapy, we can use an exact distribution of the radiation dose to additionally irradiate the tissue directly adjacent to the tumour without damaging surrounding structures such as the urethra or sphincter muscle,"said Spira." Current studies also show that radiation therapy is superior to surgery in terms of quality of life and patient satisfaction. Prof. Wolfgang Wagner, Medical Director of the Paracelsus Clinics in Osnabrück, Germany, used a very comprehensive questionnaire to analyse the quality of life of a total of 634 patients who were treated with either radical surgery, external radiation or brachytherapy (2). The results of the largest patient survey in Germany were clear: 93 percent of the patients who opted for brachytherapy were very satisfied with the choice of treatment. In contrast, satisfaction after radical surgery was 79 percent only.

After extensive consultation with two other urologists and a radiotherapist, Lothar S. finally decided on a seed implantation. As he is a self-employed mechanical engineer, he was unable to work for a longer period of time and did not want to risk incontinence, so the decision for him was quickly clear. Dr. Spira puts it in a nutshell:"The advantage of brachytherapy is that patients have to accept significantly fewer side effects for the treatment and are quickly fit again without fear of any loss in healing. According to the radiation therapist, in contrast to the USA, surgery is still too frequent in Germany. Fortunately, however, there is also a trend in Germany towards treating prostate cancer by means of ultra-modern radiotherapeutic methods,"sums up Dr. Spira. 

Literature:

Kupelian PA et. al.: Radical prostatectomy, external beam radiotherapy or =72 Gy, permanent seed implantation, or combined seeds/external beam radiother-apy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol Phys. 2004 Jan 1;58 (1): 25-33.
Wagner, W. et al. 2008: Patients` general contentment with and Quality of Life (QoL) after treatment for prostate cancer (PC) and oncological rehabilitation

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