Title: Low doserate prostate brachytherapy
1Low dose-rate prostate brachytherapy
2About this slide tutorial
- What is it?
- A self-learning slide tutorial, including
detailed slide notes, to work through at your own
pace - Part of the Prostate Brachytherapy Advisory Group
(PBAG) online nurse education programme - Why is it being provided?
- To help you understand more about prostate
brachytherapy, an increasingly popular
alternative to prostatectomy and external beam
radiotherapy (EBRT), for patients with localised
prostate cancer
3About this slide tutorial
- To view the detailed notes, select either View
Normal or View Notes Pages - To view slides on full screen (no notes visible)
select View Slide Show - To print the notes and the slides, select Print
notes pages
4NICE prostate cancer guideline
- 2008 NICE guideline on prostate cancer identified
prostate brachytherapy, along with prostatectomy
and EBRT, as one of the three proven radical
treatment options for men with low- or
intermediate-risk localised prostate cancer
2008 NICE guideline on the diagnosis and
treatment of prostate cancer
5What is prostate brachytherapy? (1)
- Prostate brachytherapy involves the transperineal
placement of radioactive seeds directly into the
prostate - This treatment delivers a high dose of radiation
directly into the prostate - During the procedure, rectal ultrasound is used
to assess the size and shape of the prostate
6What is prostate brachytherapy? (2)
- The seeds are placed into the prostate through
fine hollow needles inserted into the perineum - A grid-like device is used to guide the needles
into the correct position
- A computer program ensures that the right dose of
radiation is delivered to the prostate and that
other organs are unaffected - The seeds stay in the prostate permanently and
remain radioactive for 3-9 months
7Which patients are candidatesfor brachytherapy?
Treatment selector chart from the Prostate
Cancer Centre, Guildford
- Many patients with localised prostate cancer are
potential candidates for prostate brachytherapy - Patient characteristics including cancer risk,
age and prostate size, help to determine which
treatment is most appropriate
8What are the side-effects?
- Prostate brachytherapy is associated with fewer
complications and side-effects than other radical
treatments
Treatment selector chart from the Prostate Cancer
Centre, Guildford
9Clinical efficacy of prostate brachytherapy (1)
- Numerous clinical studies have shown that
prostate brachytherapy is highly effective at
curing cancer and prolonging survival in patients
with localised prostate cancer
10Clinical efficacy of prostate brachytherapy (2)
- Prostate brachytherapy, prostatectomy and EBRT
are equally effective at curing cancer and
prolonging survival in patients with localised
prostate cancer
1
0.8
EB72Gy
COMB
PI
0.6
bRFS
RP
0.4
RP radical prostatectomyEBRT external beam
radiotherapyPI permanent seed
implantation(LDR brachytherapy)COMB combined
seeds and EBRT
0.2
p0.18
0
0
12
24
48
60
72
36
84
Months
Kupelian et al. Int J Radiat Oncol Biol Phys 2004
11Quality of life following prostate brachytherapy
- Prostate brachytherapy, prostatectomy and EBRT
have different effects on patients quality of
life - Treatment decisions should take into account the
effects of treatment on quality of life, as well
as survival
EPIC Urinary Bother
EPIC Urinary Function
100
100
90
90
80
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
0
0
Pre-treatment
Month 1
Month 3
Month 6
Month 12
Month 24
Pre-treatment
Month 1
Month 3
Month 6
Month 12
Month 24
EPIC Sexual Function
EPIC Sexual Bother
100
100
90
90
80
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
0
0
Pre-treatment
Month 1
Month 3
Month 6
Month 12
Month 24
Pre-treatment
Month 1
Month 3
Month 6
Month 12
Month 24
Radical prostatectomy Brachytherapy Three-dimensio
nal (3D) external beam radiotherapy
Adapted from Ferrer et al. Int J Radiat Oncol
Biol Phys 2008 (Fig 4)
Higher score better function
Ferrer M et al. Int J Radiat Oncol Biol Phys
2008 72 42132.
12Advantages and disadvantages of prostate
brachytherapy
- Patients can experience transient urinary
irritative symptoms - Close contact with small children and pregnant
women should be avoided in first 2 months after
treatment
- Avoids physical trauma of a major surgical
procedure - One-off minimally invasive procedure requiring
minimal hospitalilsation - Procedure causes minimal bleeding
- Precise placement of the seeds offers more
tailored treatment - Relatively few long-term side-effects
- Quick recovery and return to normal activity
- More likely to retain quality of life compared
with other treatments - Maintains sexual potency in many patients
- Produces good long-term clinical outcomes
- Cost-effective treatment option
13How does prostate brachytherapy compare with
other radical treatments?
- Efficacy
- Equivalent efficacy to prostatectomy and EBRT
- Quality of life
- Quality of life is more likely to be retained
than after prostatectomy or EBRT - Side effects are generally not as serious sexual
side-effects are less common than after
prostatectomy - Hospital stay
- Prostate brachytherapy 1 or 2 day visits
- EBRT many day visits(5 days-a-week for 47
weeks) - Prostatectomy prolonged hospital stay (up to 1
week)
14Questions your patients may ask (1)
If I have prostate brachytherapy do I become
radioactive?
Is prostate brachytherapy a new procedure?
What about my sex-life after prostate
brachytherapy?
15Questions your patients may ask (2)
Where can I getprostate brachytherapy?
How long will it take toreturn to my
normaldaily activities?
Will the NHS pay for my treatment?
16Summary prostate brachytherapy
- An increasingly popular alternative to other
recommended radical treatments for localised
prostate cancer - Involves the transperineal placement of
radioactive seeds directly into the prostate - As effective as other recommended radical
treatments at curing cancer and prolonging
patient survival - More likely to retain quality of life than other
radical treatments
17LDR prostate brachytherapy centres in England
18UK brachytherapy centres
The number of NHS and private hospitals and
centres in the UK currently providing LDR
prostate brachytherapy are England
29 Scotland 2 (Glasgow and Edinburgh) Wales
1 (Cardiff) Ireland 2 (Dublin and Galway) For
a detailed list, download the separate file
entitled LDR brachytherapy centres available
from the website of the Prostate Brachytherapy
Advisory Group www.prostatebrachytherapyinfo.net
(See section Information for healthcare
professionals) The website also contains
additional detailed information about each centre
in the section UK brachytherapy centres.
19Further information
- Prostate brachytherapy
- See the following websites for further
information - prostatebrachytherapyinfo.net
- prostatebrachytherapycentre.com
- NICE
- Prostate cancer diagnosis and treatment clinical
guideline CG58 - nice.org.uk/guidance/CG58
- For patients
- Understanding NICE guidance
- For healthcare professionals
- The guideline in full
- Implementation advice
- Slide set
20The Prostate Brachytherapy Advisory Group (PBAG)
- Stephen Langley (Chair)
- Professor of Urology, Prostate Brachytherapy
Centre, Guildford - Niki Baier
- NHS Commissioning Advisor, Surrey
- David Bottomley
- Consultant Clinical Oncologist, St Jamess
Institute of Oncology, Leeds - Richard Gledhill
- Prostate Cancer Charity Specialist Nurse, Queen
Elizabeth Hospital, Birmingham - Philip Marazzi
- General Practitioner, East Horsley, Surrey
- Rick Popert
- Consultant Urological Surgeon, Guys and St
Thomas NHS Foundation Trust, London - Graham Robson
- Patient Representative, Aberdeen
Learn more about PBAG at www.prostatebrachytherap
yinfo.net Email the PBAG at admin_at_prostatebrachyt
herapyinfo.net The activities of the PBAG are
supported by an unrestricted educational grant
from Oncura