Treating prostate cancer with low dose-rate seed brachytherapy at the Alfred for 20 years
Introduction We have used low dose-rate radioactive-seed implant brachytherapy (“LDR brachy”) to cure prostate cancer (PCa) at the Alfred for >20 years. Aim To describe the long-term disease control and patient-reported outcome measures after LDR brachytherapy. Methods Review of prospective quality-registry of patient disease, treatment, disease-control and self-reported quality-of-life for all men treated from 1998–2013. Endpoints were PSA-control using standard (“Phoenix”) definitions, prostate-cancer-specific- and overall-survival, and standard regular surveys of adverse-effects. Results We implanted 900 men (554 with “NCCN low-risk” PCa, and 346 intermediate risk (187 NCCN “favourable” group and 159 “unfavourable”)). Median age was 62 (IQR: 57–67). The median presenting PSA was 5.4 ng/L (IQR: 4.0–7.2). After a median followup of 9.4 years, there were 16 PCa deaths, and 89 deaths from other causes. The PSA-control rate at 5, 10, and 15 years was 95%, 89%, and 85% respectively, for the whole group. The was no difference associated with patient age, year of implant, or implanting clinicians. There was a difference depending on risk factors: at ten years the PSA-control in the low-, the favourable intermediate- , and the unfavourable intermediate-risk groups was 92%, 85% and 78%. The PCa-specifc survival probabilities were 99.6%, 99%, and 96% at 5, 10, and 15 years. After 10 years followup, more than 60% of men had “no” or a “very small problem” with sexual function; major urinary and bowel problems were uncommon. Conclusion In a large prospectively-monitored group treated with LDR brachytherapy at the Alfred, over a 20 year period the disease-control rates are equivalant to that seen in the surgical arms of randomised trials of radical prostatectomy with similar low rates of side-effects as seen in large series. These effects appear sustained over long follow-up.
Jeremy Millar is Research Director at Alfred Health and has worked with a large prostate brachytherapy team there for over 20 years.