Tumor destroyed, prostate gland preserved
Organ-preserving therapies such as brachytherapy are becoming increasingly important in the treatment of prostate cancer.
While organ-preserving therapies are now standard in breast or kidney tumours, this type of treatment for prostate cancer is still in its infancy. But here too, the trend is not to remove the entire prostate, but to eliminate malignant areas while preserving the organ, according to the tenor at the latest meeting of the German Society of Urology (DGU) in Leipzig.
Thanks to modern imaging methods and special raster biopsies, urologists today are not only able to detect the tumour but also locate individual centres of tumour in the prostate. For example, tumours discovered at an early stage can be limited to a single focus or an area, such as a prostate lateral lobe. Here, it makes little sense to completely remove the prostate through radical surgery (prostatectomy) due to the favorable nature of the tumor,"emphasizes Dr. Stephan Neubauer, urologist at the West German Prostate Center," especially as subsequent complications considerably reduce the quality of life for men. According to a study conducted by the GEK, 70 percent of patients undergoing surgery complained about erection problems, 53 percent about sexual disinterest and around 16 percent about urinary incontinence (1). In addition, one in five confirmed surgical complications such as severe bleeding or intestinal injuries (1).
This can be remedied by techniques that do not remove the entire prostate gland, but only focus on parts of the prostate gland. Individual tumour centres are precisely destroyed without damaging surrounding tissue,"explains Dr. Neubauer. The advantage of "selective treatment" lies in the fact that patients have to accept significantly lower side effects for the treatment without fearing any loss of healing, according to the Cologne urologist.
Brachytherapy is particularly suitable as a technique for organ-preserving therapy in prostate cancer. Smallest radiation sources (seeds) are brought directly into the prostate gland under ultrasound control. The tumor tissue is destroyed from the inside by the high-dose radiation, while the prostate is retained 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 bladder and rectum are protected,"explains Dr. Neubauer. The more precisely we know from the preliminary examinations where the individual tumour centres are located, the more specifically we can proceed and reduce the side effects of the treatment to a minimum ".
However, brachytherapy is not only convincing because of its less complications but also because of its efficacy. Long-term studies by the renowned New York Prostate Institute (2) and own data from the West German Prostate Center (3) on prostate cancer patients show that the healing rate 10-12 years after seed implantation is 88 to 91 percent. The results are confirmed by a current metastudy4 (summary of global study data) which for the first time proves that brachytherapy achieves at least equivalent or better cure rates in all stages of the disease compared to radical surgery.
Dr. Neubauer believes that organ-preserving treatment of prostate cancer with seed implantation is the future for patients whose prostate cancer was discovered at a very early stage: This means that we can offer men with low-risk carcinoma, who decide against the Active Surveillance strategy because of uncertainty before the disease progresses, an extremely gentle but effective form of therapy compared to radical surgery.
- Barmer GEK Hospital Report 2012
- Kupelian PA et. al.: Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy > or =72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol Phys. 2004 Jan 1;58 (1): 25-33.
- Neubauer S, Derakhshani P, Weise C, Spira G: Interstitial low-dose rate mono-brachytherapy with I125 - relapse-free survival and dosimetric outcome for localised pros-tate cancer in a single European institution. Presented at the Annual Meeting of the EAU, Barcelona, Spain, April 16-20,2010
- Grimm P, Ignace Billiet I, Bostwick D et al. Comparative analysis of prostate-specific anti-gene free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Results from the Prostate Cancer Results Study Group. BJUI 109, Suppl. 1,22-29,2012