Seed implantation: therapeutic success depends on the experience of the medical team

Modern treatment methods in medicine are booming in Germany. But not everything that is new must also be good. Drugs are repeatedly withdrawn from the market due to severe side effects, and many doctors are not familiar with modern methods. The success of new therapies depends on the therapist's experience. This is shown by a recent study of the West German Prostate Center (WPZ) in Cologne.

Brachytherapy has proven to be a gentle alternative to complete removal of the prostate gland.

In seed implantation, the smallest radioactive iodine sticks are introduced into the prostate gland, which destroy the tumor from the inside through targeted radiation. Dr. Gregor Spira, radiotherapist and senior physician of the WPZ, which with well over 2,000 brachytherapies performed nationwide is one of the most experienced centers:"Our study proves that experience and constancy of the treatment team have a strong influence on the quality of radiation and the reduction of side effects during seed implantation. Over a period of three years, the analysis of data from more than 500 patients has confirmed that the more experienced the team, the more precise the planning of the radiation dose and the better the distribution of the seeds.

For the patient, this means that all cancer cells in the prostate are destroyed by the highest possible radiation and at the same time the urethra and intestine, which are located in the immediate vicinity of the prostate, are protected to a maximum. In addition, the increasing experience of the medical team has a further advantage: the duration of the intervention decreases by almost half with the skill of the team. The best possible quality of seed implantation depends on close, interdisciplinary cooperation between radiotherapists and urologists,"emphasizes Dr. Stephan Neubauer, urologist at the West German Prostate Center. Without this interlocking of competences, adequate treatment would not be possible.

Low risk alternative

Approximately 45,000 men contract prostate cancer every year. In the majority of those affected, the organ is radically removed. However, the consequences of the severe surgical procedure are sometimes fatal: 60 to 90 percent of patients are impotent after the procedure, and up to 20 percent of those affected must expect urinary incontinence. Brachytherapy has a significant advantage over total surgery at the same healing rate. The surrounding tissue outside the prostate is less affected. Most patients are spared the dreaded impotence and incontinence,"said Dr. Neubauer. In the USA, where brachytherapy has been used for more than 20 years, more patients are treated with brachytherapy than operated on.

At the beginning of the treatment, a transrectal ultrasound determines the exact size and volume of the prostate gland. Based on the acquired data, an optimal irradiation plan is created by the radiotherapist. During seed implantation, the urologist introduces radioactive grains of up to 80 millimeters in size into the prostate by means of hollow needles. This is done under ultrasound control. Dr. Stephan Neubauer commented:"The seeds must be placed with millimetre accuracy in order to achieve high efficacy and to avoid side effects such as incontinence and impotence. If the prostate carcinoma is at an advanced stage or if it is a more aggressive type of cancer, the WPZ uses afterloading therapy in combination with external radiation. Here, high-dose radiation sources are introduced into the prostate under short anaesthesia. The irradiation is repeated two to three times every week. In this procedure, too, experience about exact placement is crucial. The broad spectrum of therapies enables us to determine the most effective and gentle treatment strategy for each patient, depending on the size and nature of the tumour.

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