Challenging default clinical practice for prostate cancer


Prostate cancer (PCa) was the second largest cause of cancer death among males in 20151, much of which is attributable to patients with intermediate-and-high-risk PCa where 10-year survival is as low as 25% without treatment2. Yet despite the prevalence, burden and human impact of the disease, one of the most effective treatment options for PCa is commonly overlooked: brachytherapy. A series of misconceptions continues to thwart uptake of the treatment, preventing many patients – intermediate-and-high-risk, young and old – from being offered a viable alternative to radical prostatectomy (RP) or external beam radiation therapy (EBRT).

Yet, for more than two decades low dose-rate brachytherapy (LDR-B) has been an established treatment for PCa. The treatment is a form of internal radiotherapy that involves the insertion of tiny radioactive seeds into the prostate gland. The radiation is targeted only at the site of the tumour – killing cancer cells without causing major damage to the healthy cells that surround them. LDR-B is an efficacious equivalent to traditional treatments, with overall survival (OS) and recurrence-free survival (RFS) rates comparable with those for RP and EBRT. Moreover, it can yield important advantages in quality of life, convenience and patient experience. The procedure has a low complication rate, with most men able to return to normal activities within a few days. It also has a lower incidence of severe side-effects such as impaired sexual function and incontinence.

The application of brachytherapy – along with the technologies and techniques that underpin it – has naturally evolved. One recent innovation is 4D brachytherapy, which involves a single stage, real-time implant technique that uses simple prostate measurements under ultrasound or MRi to calculate the number of seeds required for the procedure. The process offers better targeted treatment and an improved patient experience. Another innovation has seen clinical practice progress from using LDR-B solely as a monotherapy.

In the majority of countries – Australia being one exception – the treatment can now be used in combination with external beam radiotherapy in men with intermediate-and-high-risk PCa. Evidence shows that an LDR-B boost can improve health outcomes, highlighting real potential to transform clinical practice and extend treatment options for higher-risk patients.

However, despite the evidence and the opportunity, many HCPs remain cautious around the use of LDR-B. Why? Some of the answers are rooted in myths that need debunking.

Myth #1: There is no long-term data available for low dose-rate brachytherapy (LDR-B)