chicagoprostatefoundation.org

Brian Moran,M.D. – Brachytherapy – Best Radiation Treatment for Prostate Cancer

There has been much controversy over the past several years regarding the best treatment option for prostate cancer.  To date, there is no clear-cut data to prove the advantage of surgery over other treatment options.  Recently, there has been a new enthusiasm for IMRT (Intensity Modulated Radiation Therapy) and proton beam radiation therapy for the treatment of prostate cancer.  Again, there is no data to support that either therapy is superior to brachytherapy for the treatment of prostate cancer. However, there is data suggesting that brachytherapy is superior to IMRT.  Data from the latest Meeting of the American Brachytherapy Society, presented by Michael Zelefsky, M.D. from Sloan-Kettering Cancer Center, NY (June 2009), compared 2292 patients that were treated with IMRT or brachytherapy.  Results found that the 7-year PSA relapse-free survival (PRFS) for low-risk patients was 92.4% for patients treated with brachytherapy and 91.6% for patients treated with IMRT.  However, the 7-year PRFS for intermediate-risk patients treated with brachytherapy and IMRT were 91% and 79% respectively.  There appears to be a trend to late failures with IMRT for intermediate-risk patients, thus proving the superiority of brachytherapy over IMRT.[1]  In addition, there is no data suggesting proton beam radiation therapy is better than IMRT [2].  Therefore, using the classic logic argument, if A (brachytherapy) > B (IMRT), and B = C (Proton Beam), then A > C. There will never be a randomized study of brachytherapy vs. IMRT vs. proton beam because of physician bias and patient preference.  Unfortunately, in today’s healthcare market, some physicians are making patient recommendations based on their own financial gain and not regarding the patient’s best interest. (See our blog below regarding Dr. Simone’s article “The Gullible Decade”). [3]

Aside from scientific data, there are other reasons why brachytherapy is superior to other forms of external beam radiation therapy.  A big reason is cost.  Brachytherapy is a much more cost effective form of treatment.  On average, brachytherapy runs $8,000 plus the cost of the seeds.  While the cost of IMRT ranges from $35,000 – $55,000 and proton beam therapy can exceed $100,000.  One must also look at patient consideration when evaluating treatments.  Brachytherapy is a 1-time (1 day, out-patient) procedure with a patient able to resume daily activities within 1-2 days.  However, both IMRT and proton beam therapy involve 30-60 min. treatments 5 times per week over 8 weeks.  Not to mention the travel time to and from the radiation facility which are usually not located right in a patient’s community.

In conclusion, there is much data out there to support brachytherapy as a superior therapy in the treatment of prostate cancer.

1.  Zelefsky MJ, Yamada Y, Kollmeier MA, et al: Comparison of tumor control outcomes and toxicity between LDR brachytherapy and high dose IMRT for clinically localized prostate cancer. Brachytherapy 8:105-180,2009.

2.  Nguyen PL, Trofimov A, Zietman A:  Proton-beam vs intensity-modulated radiation therapy; Which is best for treating prostate cancer? Oncology 22:748-754, 2008.

3.  Simone JV: The gullible decade. Oncology Times  6, Jan 25, 2010.

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Suicide Risk Higher in Patients Diagnosed with Prostate Cancer

According to a recent article published in Reuters (Feb. 2, 2010), being diagnosed with prostate cancer roughly doubles the risk of suicide or death from a heart attack.  A team of researchers from Harvard and Brigham & Women’s Hospital in Boston looked at data from 340,000 prostate cancer patients between 1979 and 2004.  While this particular study found that the elevated suicide risk of patients in this database has decreased since PSA screening became standard practice in 1993, there is still an increased risk of death from heart attacks and strokes.  However, a study in Sweden last month by the same team, did find an elevated suicide risk associated with PSA testing.

The stress of prostate cancer diagnosis alone has its own risks.  If you or a loved one is diagnosed with prostate cancer, please be aware that many options are available to you.  Most importantly, you need to discuss your situation with family, loved ones and physicians to help get through this difficult time. Do not try to go through it alone.

The Prostate Cancer Foundation of Chicago offers a support group the first Wednesday of every month to those who have prostate cancer. The support group meetings are from 7:00-9:00 pm at the Chicago Prostate Cancer Center, 815 Pasquinelli Drive, Westmont, Illinois  60559.

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2 Independent Studies Released on the Effectiveness of Brachytherapy for the Treatment of Prostate Cancer

Westmont, IL, August 27, 2009 – For years, the debate has been ongoing regarding the best treatment method for prostate cancer patients.  Now, two independent studies have reached similar conclusions. Already considered a good option for prostate cancer patients, brachytherapy (radiation seed implants) now has the backing of research from The Prostate Cancer Foundation of Chicago and The Taussig Cancer Center at Cleveland Clinic, proving a superior disease-free survival rate for patients with early stage prostate cancer.

            In an eleven-year study, the Prostate Cancer Foundation of Chicago, a non-profit organization that funds patient support programs, clinical research and public education, analyzed 9,137 patients treated for prostate cancer at the Chicago Prostate Center in Westmont, Il.  From October 1997 to October 2008, patients underwent prostate brachytherapy to treat their cancer.   67.5% of the patients were regarded as low risk, 29.36% as intermediate risk, and 1.01% as high risk.

Of those patients, overall cure rates were 96%, 84%, and 75% for low, intermediate, and high risk patients, respectively. When combined with external beam radiation therapy in intermediate and high risk patients, the brachytherapy results far exceed those of surgery.

The Taussig Cancer Center at The Cleveland Clinic has released their similar 2008 outcomes, demonstrating brachytherapy to be superior to surgery in all cases.  For low risk prostate cancer patients, the study found a 95% survival rate after five years; intermediate risk an 89% rate; high risk 71%.  This research concluded that, for low risk patients, brachytherapy was equally successful as external beam radiation, but more successful than a radical prostatectomy.

Michelle Braccioforte, Research Director at the Prostate Cancer Foundation of Chicago, explains, “There is a misconception that removing the prostate completely results in 100% cure, which is not true.  Not any one treatment is ever 100% successful, but brachytherapy has excellent cure rates, is a one-time, outpatient procedure, and is the most cost-effective.”

In addition to its effectiveness, brachytherapy is a minimally invasive treatment. It involves the implantation of radioactive seeds directly at the source of the cancer. Delivered by a needle and guided by ultrasound, the seeds destroy the DNA within the cancerous cell – effectively killing the tumor. Patients with prostate cancer in the T1 or T2 stages (meaning the cancer hasn’t spread beyond the prostate) choose brachytherapy for a number of reasons:

  • No incisions, minimal pain and blood loss
  • Urinary incontinence rates less than 1% – compared to 10% with surgery
  • 6-25% chance of sexual dysfunction following procedure – compared to 50% with surgery
  • Much lower rates of bowel irritation compared to external beam radiation
  • Convenience – one-time procedure done on an outpatient basis which requires no hospital stay, patients are fully recovered and can return to normal activity within a day
  • Lower cost compared to external beam radiation and surgery

 

With prostate cancer success rates on the rise, it is important to note that early detection can make all the difference when fighting prostate cancer. Doctors recommend that men have a yearly PSA test and digital rectal exam starting at age 50 – and age 40 for African-Americans.

Risk factors have been found to include:

  • Heredity – Greater risk if a father or brother has had prostate cancer
  • Age – Men over 50 are more at risk
  • Race – African-American males are more at risk

For more information on the Chicago Prostate Cancer Foundation research, visitwww.chicagoprostatefoundation.org.  For more information on the Taussig Cancer Center at Cleveland Clinic, visithttp://my.clevelandclinic.org/services/radiation_oncology/outcomes.aspx.

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Brachytherapy Excellent Choice for Any Age

For years doctors have recommended prostatectomy – surgical removal of the prostate gland – for men with prostate cancer, especially young men.  However, a new study confirms what Chicago Prostate Cancer Center doctors have believed for years – age is not a factor when men of all ages were studied to compare the success of surgery versus brachytherapy (seed implant) in patients with low-risk prostate cancer.  As stated in the article, “Young age should not be a deterrent when considering brachytherapy as a primary treatment option for clinically localized prostate cancer.”

Burri RJ, Ho AY, Forsythe K, Cesaretti JA, Stone NN, Stock RG (2009) Young Men Have Equivalent Biochemical Outcomes Compared with Older Men After Treatment With Brachytherapy for Prostate Cancer. Int J Radiat Oncol Biol Phys. 2009 Dec 29.

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Comparing Surgery vs. Brachytherapy

A recent study published out of Italy, showed that in patients with low-risk prostate cancer the disease-free survival rate was the same for both surgery (complete removal of the prostate surgically) and brachytherapy (seed implant) after five years.  200 patients were randomly split into two groups, Group 1 receiving surgery and Group 2 receiving brachytherapy.  At 6 months, brachytherapy patients did not experience any urinary incontinence, while 18.4% of the surgery group did.  Also, brachytherapy patients had much stronger erectile function recovery at 6 months.  Erectile function was also stronger at a year and at 5 years in patients who had brachytherapy over surgery.

This study showed the “cure” rate between surgery and brachytherapy to be the same; while the brachytherapy group had fewer issues with urinary incontinence early on and better sexual function overall.

Here at Chicago Prostate Cancer Center we have found similar results in our treatment of over 10,000 patients.

Gilberti C, Chiono L, Gallo F, Schenone M, Gastaldi E (2009) Radical retropubic prostatectomy versus brachytherapy for low-risk prostatic cancer: a prospective study. World J Urol27:607-612. doi 10.1007/s00345-009-0418-9

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