Research Points to Effectiveness of Brachytherapy in Early Prostate

June 1, 1997

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

Studies presented at the annual meeting of the American Urological Association(AUA) in New Orleans show positive results for the treatment of early-stageprostate cancer using brachytherapy or "seeding." The studies,conducted by Nelson Stone, md, Professor of Urology and Radiation Oncologyat the Mount Sinai School of Medicine, demonstrate that seed implants performcomparably to other conventional treatments for localized prostate cancer,offering patients another treatment option.

"This is the largest study series presented on brachytherapy atthe American Urological Association meeting in the last 10 years,"Dr. Stone said. "The findings indicate that brachytherapy is a viableoption for many of the more than 340,000 new prostate cancer cases diagnosedeach year."

Brachytherapy, or interstitial radiation, is a technique for prostatecancer treatment in which rice-sized radioactive seeds of palladium-103or iodine-125 are inserted into the prostate through a one-time, minimallyinvasive procedure.

Study Reviews Patient Selection

Richard Stock, md, associate professor of radiation oncology at MountSinai School of Medicine, and Dr. Stone presented a study to determineappropriate criteria for patient selection. During the study, more than200 patients with early-stage (T1-T2) prostate cancer were treated withradioactive seed implants. The cure rates using brachytherapy were comparableto those reported for traditional treatments of radical prostatectomy andexternal-beam radiation.

"An estimated 200,000 prostate cancer cases will be treated thisyear with radical prostatectomy or external- beam radiation which havehigh rates of complications, including impotence and incontinence,"Dr. Stone said. "Brachytherapy has fewer side effects that can negativelyimpact a patient's quality of life, while these studies further confirmbrachytherapy's effectiveness as a course of treatment."

Favorable Outcome Results

Dr. Stone also conducted a study of more than 300 patients to determinewhether localized prostate cancer could be eradicated by brachytherapy.The outcome data suggest that current prostate cancer seed implant techniquesresult in high negative prostate biopsy rates, indicating no persistenceof the disease. "This study demonstrated that all patients with localizedprostate cancer, regardless of the aggressive nature of their prostatetumors, can be effectively treated with brachytherapy," Dr. Stonesaid.

Cost-Effectiveness of Treatment Options Compared

In addition, Jeffrey Chircus, md, and Dr. Stone conducted a 2-year costanalysis of the current prostate cancer treatment options available forlocalized prostate cancer in the managed-care setting, including radicalprostatectomy, external-beam radiation therapy, cryo-ablation, and prostateseed implantation. This analysis suggests that the large cost differencesbetween treatment options may affect managed-care contracting.

Overall, the analysis indicates that the primary and secondary treatmentcosts 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.