AMELIA ISLAND, Fla--Is brachy-therapy for prostate cancer a
gimmick or a new treatment technique with numerous
advantages over either radical prostatectomy or external beam
radiotherapy? Very definitely the latter, Jay Friedland, MD, of the
H. Lee Moffitt Cancer Center, Tampa, said at the Southern Association
for Oncology (SAO) 11th annual meeting.
Brachytherapy is the transperineal TRUS (transrectal
ultrasound)-guided interstitial implantation in the prostate of
permanent radioactive "seeds" at the site of neoplastic
The two radiation treatments used most often in prostate cancer today
are high-dose 3D conformal radiotherapy and brachytherapy, Dr.
Friedland said. "However, I find in my travels that most people
dont understand brachytherapy," despite an improved
understanding of prostate cancer in recent years.
For example, he said, physicians now know that the pubic arch and
prostate comprise a 3D structure and that the prostate is composed of
different zones. Seventy percent of all prostate cancers occur in the
peripheral zone, which wraps around the outside of the prostate; 20%
to 25% occur in the transitional zone; and only 5% develop in the
central zone. The placement of the seeds is planned so as to give an
appropriate radiation dose to each of the different zones of the
prostate, he said.
Exclusion criteria for brachytherapy are similar to those for radical
pros-tatectomy: high PSA level (more than 20 ng/mL), large prostate,
pubic arch interference, and inability to receive either spinal or
Prostate brachytherapy was initially a "patient driven"
technique, Dr. Friedland noted, but over the last several years, the
medical literature in support of the treatment has begun to catch up
with patients perceptions of its value.
"A careful review of the medical literature reveals that, if one
uses PSA as the endpoint for successful therapy, there are published
data with essentially equivalent follow-up (5 to 8 years) for
prostate brachytherapy, external beam radiotherapy, and radical
prostatectomy," Dr. Friedland said. "The outcomes for all
three are essentially the same in patients with PSA levels less than
10 ng/mL, Gleason score of 6 or less, and T2a or lower tumor
For patients with parameters greater than the above, radical
prostatectomy and brachytherapy are equivalent, he said, while
conventional external beam radiotherapy is inferior. In addition, Dr.
Friedland pointed out, brachytherapy has the most favorable toxicity
profile of all the treatment options.
"It is my belief that brachytherapy is not only an excellent
treatment option but the ultimate in conformal prostate
radiotherapy," he said.