Figure 2: PSA relapse Free Survival. (Lamb et al 2018)
Side effects to be considered
Erectile dysfunction (ED), urinary symptoms and bowel symptoms are side effects that need to be considered when treating prostate cancer, with ED often considered an important factor by patients. Perhaps the main advantage of LDR brachytherapy is the low risk of permanent side-effects.13
In the two months following LDR brachytherapy, men may experience temporary but significant urinary irritation and bother, however this can often be successfully managed. Late urinary bother occurs in 10% of men, urethral strictures in 2-3%, with urinary incontinence not commonly seen. Bowel toxicity is also rare, with low occurrence of significant rectal bleeding or ulceration.10,11,13,14
Evidence suggests LDR brachytherapy offers the lowest risk to erectile function compared to many other prostate cancer treatments, with Ong et al reporting 60% of men preserved excellent erectile function in the five years following treatment.15 In younger men, the erectile preservation rate was 70%.
In New Zealand, LDR brachytherapy is a combined procedure performed by both a radiation oncologist and urologist. However, the procedure also requires a multidisciplinary team including radiation therapists, medical physicists, as well as the theatre staff. The procedure is performed under general anesthetic and usually takes about an hour, with patients able to return home on the same or following day.
Unfortunately, despite the well-established use of LDR brachytherapy in New Zealand and around the world, the treatment is currently only available through New Zealand’s private health system. There is a need to improve public access to this option.
Making a treatment decision
The choice of prostate cancer treatment is a big decision for many men, and the amount of information on therapy options can be overwhelming. However, as prostate cancer is often slow growing, men and their families have an opportunity to explore all of their treatment options.
Alongside urologists and radiation oncologists, GPs play a key role in the early detection of prostate cancer through to the ongoing care of men being treated for the disease, and importantly, empowering patients and their families to make informed treatment decisions and manage side effects.
Men diagnosed with prostate cancer should be encouraged to seek multidisciplinary consultation and speak with both a urologist and radiation oncologist before making a treatment decision. We hope to see increased awareness and improved access to all treatment options for New Zealand men diagnosed with prostate cancer.
Visit the targeting cancer website for more information on radiation treatment options.
View references (opens to PDF).