Avoiding Incontinency: Brachytherapy favours Prostatectomy

The radical removal of the prostate leads to permanent loss of urine (incontinence) in a significant percentage of patients. This is again shown by a subgroup analysis of the large-scale ProtecT study, which was published in the renowned journal European Urology in 2020.

Scientists from the University of Oxford and Bristol examined more than 2,500 patients with localized prostate cancer who either underwent radical removal of the prostate (prostatectomy) or radiation therapy - including brachytherapy (internal radiation) - or were actively monitored in a close-meshed monitoring system (active surveillance). The men were then followed up over a period of 10 years. During this time, the scientists recorded possible side effects of the therapy at certain intervals using standardised questionnaires.

Urinary incontinence most pronounced after surgery

The results of the subgroup analysis showed that patients after prostate surgery suffered most from the consequences of the treatment. The most serious effects of prostate removal had on the ability of men to hold urine: For example, one-fifth of the patients whose prostate had been surgically removed were still dependent on templates after three years, and this did not change in the following three years. Patients who received external radiation therapy or brachytherapy (internal radiation), on the other hand, had hardly any loss of urinary incontinence compared to the control group (active surveillance).

Brachytherapy: Incontinence rate close to zero

"Due to the high-precision radiation of the prostate gland as part of brachytherapy, the urinary incontinence rate of patients remains at a very low level even years after the end of treatment", confirms Dr. Pedram Derakhshani, urologist at the West German Prostate Center, the current results. In this procedure, very small radiation sources (seeds) are introduced directly into the tumor. The seeds remain there for several months and deliver high-dose radiation specifically to the tumor tissue. This has the advantage that the tumour is destroyed without damaging surrounding healthy tissue such as the bladder, colon or sphincter.
Massive restriction of the quality of life due to incontinence

"Losses in quality of life as a result of surgery are all the more serious because many men with prostate cancer still undergo unnecessary surgery," Dr. Derakhshani sums up. The loss of the ability to hold urine is one of the problems that patients with prostate cancer fear most after treatment. This makes it all the more important to inform patients in advance about the side effects of the various treatment options, says the Cologne urologist.

Neal DE, Metcalfe C, Donovan JL et al: Ten-year Mortality, Disease Progression, and Treatment-related Side Effects in Men with Localised Prostate Cancer from the ProtecT Randomised Controlled Trial According to Treatment Received.  Eur Urol. 2020 Mar;77(3):320-330.

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