BRACHYTHERAPY IS AN EFFECTIVE AND WELL-TOLERATED TREATMENT FOR LOCALIZED PROSTATE CANCER RECURRENCE IN SELECTED PATIENTS

CHICAGO - Brachytherapy, an outpatient procedure that implants radioactive seeds the size of rice grains inside cancerous prostate tissue, has proved to be safe and effective in the initial, primary treatment of some men with prostate cancer confined to the gland. According to a study presented at the 2003 Clinical Congress of the American College of Surgeons, brachytherapy also may be effective in the treatment of selected men with recurrent prostate cancer. A retrospective review of 20 men who underwent brachytherapy for recurrent prostate cancer showed that most of the men had no evidence of disease four years after treatment and none suffered a major complication.

The men in the study were initially treated with external beam radiation [a procedure that directs beams of high-energy radiation from an external source to cancerous targets in the prostate], which was thought to be a contraindication to brachytherapy for recurrent disease. "Urologists have not traditionally used brachytherapy as secondary treatment for men with recurrences of prostate cancer. Physicians felt that once patients had external beam radiation, they would not be able to tolerate radioactive seed implantation because the combination would cause too many side effects," Robert E. Weiss, MD, FACS, associate professor of surgery at the Robert Wood Johnson Medical School, New Brunswick, NJ, explained.

However, only 10 percent of the men in the study of brachytherapy after primary external beam radiation had hematuria [blood in the urine], which was a transient side effect; 35 percent had symptoms of an irritable bladder; and 25 percent of those who were potent prior to the procedure had erectile dysfunction. The rate of these complications is similar to the complication rate in men who have brachytherapy as initial treatment of prostate cancer. Only one complication occurred in more than half the men in the study: urinary obstruction affected 55 percent of the men; however, in all but one man, the complication resolved spontaneously, Dr. Weiss reported.

In addition, 70 percent of the men in the study were free of prostate cancer after four years of follow-up care. "We were able to bring down the prostate specific antigen level [the blood test for prostate cancer] to normal in these men; so the use of brachytherapy produced good control of the disease," Dr. Weiss said.

Men in the study had recurrent cancer that had not spread beyond the prostate gland. Each man had a biopsy confirming the presence of recurrent cancer within the prostate and computed tomography (CT) and bone scans showing the absence of metastatic disease. The men received radioactive seed implants that were targeted to areas of the prostate gland with biopsy-confirmed cancer recurrence.

The researchers cautioned that brachytherapy must be studied further in a prospective, randomized study of men with recurrent, localized prostate cancer before definitive conclusions can be made about its effectiveness and tolerability after external beam radiation. However, this preliminary study indicates that the procedure may be an alternative to other therapies, such as surgery or hormone depletion, that have higher complication rates and lower rates of disease control in this patient population, Dr. Weiss said.

Dr. Weiss and his colleagues plan to further investigate brachytherapy as a treatment for prostate cancer recurrence after external beam radiation in a prospective randomized trial. "We would focus on the same types of patients - men with proven localized disease recurrence - and test brachytherapy as a secondary, potentially disease-curing treatment," he said.

Murali K. Ankem, MD, Edward Soffen, MD, and Stuart Kesler, MD, joined Dr. Weiss in the study of brachytherapy for the treatment of recurrent localized prostate cancer.

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