LDR Brachytherapy superior to Prostatectomy

Men who have been diagnosed with prostate cancer benefit from seed implantation even in the long term. This has recently been confirmed by a study by the British Columbia Cancer Agency in Vancouver. The high effectiveness combined with very low side effects makes the radiotherapeutic method the therapy of choice for localized prostate carcinoma. 

In almost 80 percent of the cases, prostate cancer is at a stage at the time of diagnosis where the tumor is limited to the organ and the chance of cure is very good. There are several ways to treat a localized prostate carcinoma. The established methods include radiotherapy with external (external) radiation and brachytherapy, as well as surgery and the strategy of active surveillance. 

Brachytherapy is a modern form of radiation in which the prostate is irradiated from the inside through the implantation of a few millimeter-sized radiation sources (see seed implantation).  This has the advantage that neighbouring organs such as the urethra, bladder and rectum are optimally protected against possible radiation damage. For a long time, brachytherapy was regarded in Germany as an alternative to conventional surgery,"explains Dr. Stephan Neubauer from the West German Prostate Center in Cologne. Scientific research clearly shows that the efficacy of brachytherapy - and thus the possibility of a complete cure for cancer - is at least equivalent to surgery. 
In the case of tumours in advanced stages (intermediate and high-risk carcinomas), the effectiveness of brachytherapy is even superior to surgery. In addition, the side effects resulting from the treatment are significantly lower,"said Neubauer. Losses in the ability to hold urine and potency problems in particular cause problems for men after surgery. 

Seed implantation highly effective 
But men with localized prostate cancer also benefit from seed implantation in the long term, as a recent study1 by the British Columbia Cancer Agency has shown. A total of 2339 men with prostate cancer were treated in a low and medium stage with seed implantation. About half of the study participants also received hormone treatment. After an average follow-up of 7.5 years, 87 percent of patients continued to have a stable PSA value (PSA below 0.04). Six per cent showed a slightly increased PSA value and nine per cent showed a PSA value greater than 2, which is to be evaluated as a biochemical recurrence. Patients who had previously received hormone therapy showed a better long-term efficacy of seed implantation. 

Surgery cuts worse than surgery
In contrast, a study2 by the University of Toronto in 2643 prostate cancer patients treated with a radical prostatectomy showed that only 79 percent with low risk and 59 percent with medium risk showed stable PSA (PSA below 0.05) after five years. 

West German Prostate Center confirms study data
Dr. Neubauer from the West German Prostate Center is able to confirm the excellent long-term efficacy of brachytherapy with his own patient data. Since 2000, we have carried out more than 7000 brachytherapies, 1800 of which alone have been treated with permanent seed implantation for low-risk prostate cancer and followed up over a period of up to 17 years,"said the urologist and pioneer of brachytherapy in Germany. "We can fully confirm the data collected from Canada based on our own surveys."

1 Tetreault-Laflamme A, Crook J, Hamm J,: Long-Term Prostate Specific Antigen Stability and Predictive Factors of Failure after Permanent Seed Prostate Brachytherapy. J Urol. 2018 Jan; 199 (1): 120-125. doi: 10.1016/y. juro. 2017.07.089. Epub 2017 Aug 19.

2 Louis AS, Kalnin R, Maganti M et al.: Oncologic outcomes following radical prostatectomy in the active surveillance era. Can Urol Assoc J. 2013

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