How does brachytherapy compare?
LDR brachytherapy (seed implantation) is one of three radical* treatments for men with low risk or intermediate risk localised prostate cancer. The other treatments are surgery (radical prostatectomy - complete removal of the prostate gland) or external beam radiotherapy.
The time spent in hospital is shorter with LDR brachytherapy, often only a day or two rather than many repeat visits and/or stays, and the recovery time is fast.
LDR brachytherapy is associated with fewer complications than the other radical* treatments; overall side effects are not as serious and men can return to their usual daily activities more quickly.
* Radical means treatments which are designed to remove or kill the cancer cells
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Localised prostate cancer can be treated in several different ways. Your doctor will discuss appropriate options with you based on the stage of your cancer, your age, possible side effects and whether your disease might potentially develop over time, and of course, your own personal preferences. You are likely to have a number of different tests carried out before and after your diagnosis is made. These tests will also help to monitor your treatment to see how well it is working. When the results of your tests are first received there will typically be a number of options available to you. If your disease is mild to moderate but still localised (i.e. contained inside the prostate gland) you may be offered one or more of the therapies discussed below.
In February 2008 the government issued guidance to doctors through the National Institute of Health and Clinical Excellence (NICE), on how best to treat prostate cancer (see NICE guideline CG 58). For men with localised prostate cancer (cancer which has not spread outside the prostate gland) they listed 5 options.
Watchful waiting: Prostate cancer is usually slow-growing and in the early stages it may not cause any problems, therefore your doctor might suggest that you wait to see if there is any change (your doctor will continue to keep an eye on you).
Active surveillance: This means that whilst you will have no treatment for the cancer, you will be kept under close observation and continuous monitoring by your specialist. If there is any evidence of disease progression a radical* treatment - either prostatectomy, brachytherapy, or radiotherapy (see below) - will be discussed with you.
The radical treatments are all similar in terms of long-term disease-free survival but there are differences in the impact on a man's quality of life.
What Is It?
Radical prostatectomy is surgery to remove the whole prostate gland. It is a complex and major operation.
How long does it take? The patient usually stays in hospital for 3-7 days and may go home with a urinary catheter (tube) in place through which urine is passed. It may be necessary to stay home from work for up to 6 weeks, and driving is not usually possible for 4 weeks.
Surgery - usually a single operation
Knowing the tumour has been removed
It is major surgery and patients have to stay in hospital for up to 1 week.
It is not well tolerated in older men or in men who are not in overall good health
The side effects from surgery include impotence (inability to have an erection) in a high percentage of patients, and incontinence (a loss of urinary control) in a small number of men
LDR brachytherapy is usually given on its own but in certain circumstances it may be given in combination with external beam radiotherapy (EBRT) or after a course of hormonal therapy, which is sometimes used to shrink the size of the prostate gland.
Buron C, Le Vu B, Jean-Cosset J-M et al. Brachytherapy versus Prostatectomy In Localized Prostate Cancer: Results of a French Multicenter Prospective Medico-Economic Study. Int. J. Radiation Oncology Biol. Phys. 2007, Vol. 67, No. 3, Pp. 812-822
Frank SJ, Pisters LL, Davis J et al. An Assessment of Quality of Life Following Radical Prostatectomy, High Dose External Beam Radiation Therapy and Brachytherapy Iodine Implantation as Monotherapies for Localized Prostate Cancer. J Urol 2007. Vol. 177, 2151-2156
Langley SEM, Laing R. Prostate brachytherapy has come of age: a review of the technique and results BJU International 2002;89:241-249