PALM BEACH, Fla--With more early-stage prostate cancers being detected, and with growing demand from patients, use of brachytherapy in prostate cancer is expected to increase substantially over the next decade, John C. Blasko, MD, said at the American Brachytherapy Society meeting.
In 1995, there were 244,000 new prostate cancer cases, 120,000 treated with radical prostatectomy, 35,000 with external beam radiation, and only 6,000 with brachytherapy. Projections for 2005 show 438,000 new cases, of which 110,000 will be treated with brachytherapy, said Dr. Blasko, professor of radiation oncology, University of Washington.
"In marketplace predictions, brachytherapy has a bright future," he said. It has overcome some of the difficulties of the early 1970s before ultrasound and other computer imaging technologies were available to help guide the procedure. "Patients who are self-educated about their disease are hearing about the new state-of-the-art brachytherapy and are beginning to clamor for it," he added.
From the patient's perspective, the advantages of brachytherapy are that it's an "easy" treatment: Complications are few, it's effective, and relatively inexpensive. This perception, for the most part, is true, Dr. Blasko said: The therapy can deliver a high intraprostatic dose of radiation, has a lower adjacent organ dose, and is well tolerated. However, he added, it is a therapy that requires exacting placement of the radioactive seeds for success.
Brachytherapy as monotherapy is very effective in patients with early stage T1-T2 disease, Gleason score of 2 to 6, and initial PSA less than 10 ng/mL, he said. These patients maintain a biochemical cure rate of 85% at seven years.
Brachytherapy as a boost to external beam radiotherapy has proved highly effective in patients with clinical stage T2b-T3 cancer, Gleason score 6-10, and higher-risk initial PSA levels of 10-20 ng/mL. "Conceptually, it offers a more effective treatment for periprostatic tissues and a higher prostatic dose than external beam alone," he said. "It is therefore better suited for high volume, bulkier cancers."
The disadvantage, of course, is that combining therapies increases the expense of treatment. "For this form of therapy to be beneficial and to work in today's medicosocial environment," he said, "we're going to have to prove that it's not just a useful adjuvant treatment, but one that is better than conventional therapies."