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Organ-preserving therapies, such as brachytherapy, are becoming increasingly important in the treatment of prostate cancer
While organ-preserving therapies are now standard for breast or kidney tumors, this type of treatment is still in its infancy for prostate cancer. But here, too, the trend in the future is not to remove the entire prostate, but to eliminate malignant areas while preserving the organ, according to the tenor at the recent conference of the German Society of Urology (DGU) in Leipzig.
Thanks to modern imaging techniques and special grid biopsies, urologists are now able not only to detect the tumor but also to localize individual tumor foci in the prostate. Thus, tumors detected early may be confined to one focus or area, such as a prostate side lobe. "In such cases, it makes little sense to completely remove the prostate gland by radical surgery (prostatectomy)due to the favorable characteristics of the tumor," emphasizes Dr. Stephan Neubauer, urologist at the West German Prostate Center, especially since secondary complications considerably limit the men's quality of life. According to a study by the GEK, 70 percent of those who underwent surgery complained of erection problems, 53 percent of sexual disinterest and around 16 percent of urinary incontinence (1). One in five also confirmed surgery-related complications such as heavy bleeding or bowel injuries (1).
This can be remedied by techniques that do not remove the entire prostate, but instead focus on parts of the prostate in a targeted manner. "Individual tumor foci are precisely destroyed without affecting surrounding tissue," explains Dr. Neubauer. The advantage of "selective treatment" is that patients have to accept significantly fewer side effects for the treatment without fearing losses in healing, according to the Cologne urologist.
Brachytherapy suitable
Brachytherapy is the most suitable technique for organ-preserving therapy of prostate cancer. In this procedure, tiny radiation sources (seeds) are introduced directly into the prostate under ultrasound guidance. The tumor tissue is destroyed from within by the high-dose radiation, while the prostate remains intact as an organ. "Using state-of-the-art computer technology, it is possible to place the seeds so precisely in the prostate that the tumor is destroyed but surrounding structures such as the urinary bladder and rectum are protected," explains Dr. Neubauer. "The more precisely we know, based on the preliminary examinations, where the individual tumor foci are located, the more targeted we can proceed and reduce the side effects of the treatment to a minimum."
However, brachytherapy is convincing not only because of fewer secondary complications but also in terms of its effectiveness. Long-term studies of the renowned New York Prostate Institute (2) and own data of the West German Prostate Center (3) on prostate cancer patients show that the cure rate 10-12 years after seed implantation is 88 to 91 percent. These results are confirmed by a recent metastudy4 (summary of worldwide study data), which demonstrates for the first time that brachytherapy achieves at least equivalent or better cure rates in all disease stages compared to radical surgery
Dr. Neubauer sees the organ-preserving treatment of prostate cancer by means of seed implantation as the future for patients whose prostate cancer was discovered at a very early stage: "This allows us to offer men with low-risk carcinoma who decide against the strategy of active surveillance due to uncertainty about the progression of the disease an extremely gentle but equally effective form of therapy compared to radical surgery.