Brachytherapy for prostate cancer

Findings by SBU Alert

This is a translation of version 1, published on February 2, 2000. The latest version of this report is not available in English.

Brachytherapy is not widely used in Sweden to treat localized prostate cancer. This treatment method has been available for some time, but recent advancements in technology are leading to increased utilization. Findings from isolated, uncontrolled studies of high dose rate brachytherapy in combination with external beam radiotherapy suggest some improvement in treatment outcomes. However, prospective, controlled studies are not available, and the improved outcomes may be explained by use of the method to treat smaller tumors. The type and frequency of side effects are similar to those from external beam radiotherapy, but there may be a somewhat higher rate of serious problems as the method is being established.

Currently, there is poor* scientific evidence concerning the patient benefits, short-term effects, and risks of the method. There is no* scientific evidence regarding its cost-effectiveness and long-term effects.

Since there is no evidence to show that brachytherapy is superior to other treatment or no treatment in managing localized prostate cancer, the method should be used only within the framework of controlled clinical studies until further evidence becomes available.

*This assessment by SBU Alert uses a 4-point scale to grade the quality and evidence of the scientific documentation. The grades indicate: (1) good, (2) moderate, (3) poor, or (4) no scientific evidence on the subject.

This summary is based on a report prepared at SBU in collaboration with Anders Widmark, Assoc Prof, Norrland’s University Hospital in Umeå. It has been reviewed by the Scientific Advisory Committee in Urology of the National Swedish Board of Health and Welfare.

Alert is a joint effort by the Swedish Council on Technology Assessment in Health Care (SBU), the Medical Products Agency, the National Board of Health and Welfare, and the Federation of Swedish County Councils.

References

1. Borghede G, Hedelin H, Holmang S, Johansson KA, Aldenborg F, Pettersson S, et al. Combined treatment with temporary short-term high dose rate iridium-192 brachytherapy and external beam radiotherapy for irradiation of localized prostatic carcinoma. Radiother Oncol 1997;44(3):237-44.
2. Borghede G, Hedelin H, Holmang S, Johansson KA, Sernbo G, Mercke C. Irradiation of localized prostatic carcinoma with a combination of high dose rate iridium-192 brachytherapy and external beam radiotherapy with three target definitions and dose levels inside the prostate gland. Radiother Oncol 1997;44(3):245-50.
3. D'Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer [see comments]. JAMA 1998;280(11):969-74.
4. Hanks GE, Hanlon AL, Pinover WH, Horwitz EM, Schultheiss TE. Survival advantage for prostate cancer patients treated with high-dose three-dimensional conformal radiotherapy [see comments]. Cancer J Sci Am 1999;5(3):152-8.
5. Mate TP, Gottesman JE, Hatton J, Gribble M, Van Hollebeke L. High dose-rate afterloading 192Iridium prostate brachytherapy: feasibility report. Int J Radiat Oncol Biol Phys 1998;41(3):525-33.
6. Paul R, Hofmann R, Schwarzer JU, Stepan R, Feldmann HJ, Kneschaurek P et al. Iridium 192 high-dose-rate brachytherapy--a useful alternative therapy for localized prostate cancer? World J Urol 1997;15(4):252-6.
7. Syed AM, Puthawala A, Austin P, Cherlow J, Perley J, Tansey L et al. Temporary iridium-192 implant in the management of carcinoma of the prostate. Cancer 1992;69(10):2515-24.
8. Stromberg J, Martinez A, Gonzalez J, Edmundson G, Ohanian N, Vicini F et al. Ultrasound-guided high dose rate conformal brachytherapy boost in prostate cancer: treatment description and preliminary results of a phase I/II clinical trial. Int J Radiat Oncol Biol Phys 1995;33(1):161-71.
9. Stromberg JS, Martinez AA, Horwitz EM, Gustafson GS, Gonzalez JA, Spencer WF et al. Conformal high dose rate iridium-192 boost brachytherapy in locally advanced prostate cancer: superior prostate-specific antigen response compared with external beam treatment [see comments]. Cancer J Sci Am 1997;3(6):346-52.
10. Vicini FA, Kini VR, Edmundson G, Gustafson GS, Stromberg J, Martinez A. A comprehensive review of prostate cancer brachytherapy: defining an optimal technique. Int J Radiat Oncol Biol Phys 1999;44(3):483-91