Market Is Driving Increased Brachytherapy Use in Prostate Cancer

PALM BEACH, Fla--With more early-stage prostate cancers being detected,and with growing demand from patients, use of brachytherapy in prostatecancer is expected to increase substantially over the next decade, JohnC. Blasko, MD, said at the American Brachytherapy Society meeting.

In 1995, there were 244,000 new prostate cancer cases, 120,000 treatedwith radical prostatectomy, 35,000 with external beam radiation, and only6,000 with brachytherapy. Projections for 2005 show 438,000 new cases,of which 110,000 will be treated with brachytherapy, said Dr. Blasko, professorof 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 beforeultrasound and other computer imaging technologies were available to helpguide the procedure. "Patients who are self-educated about their diseaseare hearing about the new state-of-the-art brachytherapy and are beginningto clamor for it," he added.

From the patient's perspective, the advantages of brachytherapy arethat 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 ofradiation, has a lower adjacent organ dose, and is well tolerated. However,he added, it is a therapy that requires exacting placement of the radioactiveseeds for success.

Brachytherapy as monotherapy is very effective in patients with earlystage T1-T2 disease, Gleason score of 2 to 6, and initial PSA less than10 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 highlyeffective in patients with clinical stage T2b-T3 cancer, Gleason score6-10, and higher-risk initial PSA levels of 10-20 ng/mL. "Conceptually,it offers a more effective treatment for periprostatic tissues and a higherprostatic dose than external beam alone," he said. "It is thereforebetter suited for high volume, bulkier cancers."

The disadvantage, of course, is that combining therapies increases theexpense of treatment. "Forthis form of therapy to be beneficial and to work in today's medicosocialenvironment," he said, "we're going to have to prove that it'snot just a useful adjuvant treatment, but one that is better than conventionaltherapies."