Studies presented at the annual meeting of the American Urological Association (AUA) in New Orleans show positive results for the treatment of early-stage prostate cancer using brachytherapy or "seeding." The studies, conducted by Nelson Stone, md, Professor of Urology and Radiation Oncology at the Mount Sinai School of Medicine, demonstrate that seed implants perform comparably to other conventional treatments for localized prostate cancer, offering patients another treatment option.
"This is the largest study series presented on brachytherapy at the American Urological Association meeting in the last 10 years," Dr. Stone said. "The findings indicate that brachytherapy is a viable option for many of the more than 340,000 new prostate cancer cases diagnosed each year."
Brachytherapy, or interstitial radiation, is a technique for prostate cancer treatment in which rice-sized radioactive seeds of palladium-103 or iodine-125 are inserted into the prostate through a one-time, minimally invasive procedure.
Study Reviews Patient Selection
Richard Stock, md, associate professor of radiation oncology at Mount Sinai School of Medicine, and Dr. Stone presented a study to determine appropriate criteria for patient selection. During the study, more than 200 patients with early-stage (T1-T2) prostate cancer were treated with radioactive seed implants. The cure rates using brachytherapy were comparable to those reported for traditional treatments of radical prostatectomy and external-beam radiation.
"An estimated 200,000 prostate cancer cases will be treated this year with radical prostatectomy or external- beam radiation which have high rates of complications, including impotence and incontinence," Dr. Stone said. "Brachytherapy has fewer side effects that can negatively impact a patient's quality of life, while these studies further confirm brachytherapy's effectiveness as a course of treatment."
Favorable Outcome Results
Dr. Stone also conducted a study of more than 300 patients to determine whether localized prostate cancer could be eradicated by brachytherapy. The outcome data suggest that current prostate cancer seed implant techniques result in high negative prostate biopsy rates, indicating no persistence of the disease. "This study demonstrated that all patients with localized prostate cancer, regardless of the aggressive nature of their prostate tumors, can be effectively treated with brachytherapy," Dr. Stone said.
Cost-Effectiveness of Treatment Options Compared
In addition, Jeffrey Chircus, md, and Dr. Stone conducted a 2-year cost analysis of the current prostate cancer treatment options available for localized prostate cancer in the managed-care setting, including radical prostatectomy, external-beam radiation therapy, cryo-ablation, and prostate seed implantation. This analysis suggests that the large cost differences between treatment options may affect managed-care contracting.
Overall, the analysis indicates that the primary and secondary treatment costs for radical prostatectomy and external-beam radiation are similar, and yet, when compared to brachytherapy are at least 60% more expensive. Although cryoablation offers a minor cost-savings over radical prostatectomy, brachytherapy appears to be the most cost-effective treatment option available.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
