Recent study concludes that permanent low-dose-rate brachytherapy is as effective in the treatment of low to intermediate risk prostate cancer as external beam radiation therapy (EBRT), but is less toxic. Brachytherapy treatment is also far less costly.
A study carried out by the Cleveland Clinic between 1996 and 2007 looked at the data from 1,989 of their prostate cancer patients treated by permanent low-dose-rate brachytherapy monotherapy. The patients had a median age of 67, and the median follow-up times were 6.8 years and 5.8 years, respectively.
Researchers found that as well as being effective for low-risk and low-intermediate-risk prostate cancer, low-dose-rate brachytherapy also appeared to be effective for high-intermediate-risk and high-risk prostate cancer (although sample group sizes for the last two categories were more limited). Overall, significant long-term toxicities were rare when brachytherapy was performed as monotherapy, according to study results.
Despite these findings and positive data, which mirror findings in a number of other studies, the use of low-dose-rate brachytherapy in the treatment of prostate cancer is in decline whilst the use of EBRT (or forms of EBRT) is on the increase. It is believed the reasons behind this can be attributed to a number of factors but financial incentive for referring clinicians (EBRT more lucrative) and technical skills required to perform treatments were cited by the authors. Although for the healthcare system brachytherapy appears to be overwhelmingly the most cost effective solution even potentially costing less than active surveillance. According to a 2013 Georgetown University study, the mean estimated cost for prostatectomy or brachytherapy is about $17,000, compared with Intensity Modulated Radiation Therapy (a form of EBRT), which is about $32,000.
Brachytherapy’s efficacy in controlling disease in the Cleveland Clinic study was consistent with other large published series. Of course there are other treatments available for prostate cancer (including surgery and active surveillance to name just two), but this study highlights some of the benefits of brachytherapy over the use of one of the most commonly used treatments in the US today. It is important to note that each individual’s situation is different, and the most suitable treatment for one person may not be the same for another. Men diagnosed with prostate cancer must be given the facts surrounding each viable treatment so that they, together with their doctor, can make the right decision for them.
Petereit DG et al. Where have you gone, brachytherapy? Journal of Clinical Oncology. Published online Feb. 9, 2015, doi:10.1200/JCO2014.59.8128.