Study Shows Seed Implants a Suitable Prostate Cancer
Treatment Option for Older Men
Prostate cancer treatment outcomes are impacted by
disease-related risk factors but not by age
Aug. 4, 2009 - Men diagnosed with prostate cancer
have a number of treatments to choose from, but it's a daunting task to
figure out the right mix of therapies. Trends among medical
professionals have been to favor some treatments for younger men, and
others for older patients. A new study by scientists at The Feinstein
Institute for Medical Research and North Shore-LIJ Health System have
found that age doesn't make a difference in the long-term therapeutic
outcome.
Louis Potters, MD, chairman of radiation medicine
at North Shore University Hospital and LIJ Medical Center, and his
colleagues identified 2,119 consecutive prostate cancer patients treated
between 1992 and 2005, and narrowed their selection to men under 60
years old.
Their treatment regimens consisted of
● permanent prostate brachytherapy, with or without hormone therapy,
● permanent prostate brachytherapy with external beam radiation, or
● a combination of those therapies.
The 237 patients had been followed for an average
of 56 months after treatment. They wanted to see whether there was a
difference in the rate of progression among the treatments and if it had
anything to do with the age of the patient or disease-related risk
factors.
Age didn't seem to factor into the treatment
equation, said Dr. Potters. Findings of the study were published in
The Journal of Urology.
"There is a whole politic to prostate cancer
treatments," added Dr. Potters. "But the bottom line is that
brachytherapy is an appropriate option for men at any age."
Prostate brachytherapy, or "seed implants" is the
use of radiation implanted in the body itself. The idea dates back to
1913 when surgeons inserted a radium capsule into the prostatic urethra,
the canal that runs from the bladder to the prostate.
Implanting radioactive material locally to stop the
growth of cancer cells was more art than science until the 1980's, when
the development of transrectal ultrasound allowed surgeons to have a
clearer view of the target tissue. It is critical that the implant
delivers an effective dose to the prostate while avoiding surrounding
organs.
The targeted use of radiation continues to be a
common treatment option for men with clinically localized prostate
cancer. The goal of any treatment is to stop the disease from
progressing.
Dr. Potters said that the urological community
generally refers younger patients for radical prostatectomy -- the
surgical removal of the prostate -- over radiation or no therapy at all.
Better screening and detection methods are discovering prostate cancer
earlier in men.
Knowing the long-term outcomes for each of the
available treatments across the mid-to-late lifespan is vital.
"It is even more important to understand treatment
options and associated outcomes for younger patients diagnosed with
prostate cancer," Dr. Potters and his colleagues wrote in the paper.
In a study of 2,119 patients in different clinical
stages of the disease, scientists looked at the five and 10-year
so-called "freedom from progression" (FFP). About 11 percent of those
patients were under age 60.
At five years, 90 percent of those who underwent
the seed implant were treated successfully; and at 10 years, 86 percent
had successful outcomes. Those rates did not change when the population
was stratified into two groups under 60 years old and over.
"It appears that a prostate implant, when performed
well, is an effective treatment option for younger patients," Dr.
Potters said. "Therefore, patient age should not bias one's options."
Each year, about 230,000 men are diagnosed with
prostate cancer, one of the most common cancers in men over age 50.
Treatment for localized disease remains controversial.
About 20 percent of tumors never grow larger, even
without treatment. Scientists are trying to figure out who these
low-risk patients are and keep a watchful eye on them. There is
intriguing evidence from autopsy studies that one in three men had
prostate cancer that was not diagnosed when they were alive.
Is surgery best for younger patients? Is prostate
brachytherapy as effective as surgery in reducing the risk of disease
progression and death over a five-to-10-year period? And what are the
benefits of seed implantation versus directing radiation beams at the
tumor?
"There is no gold standard for outcomes in younger
men with prostate cancer," said Dr. Potters. According to the new
findings, he said, "Outcomes are impacted by disease-related risk
factors but not by age."
He added that the advantage to brachytherapy is
that the risk for incontinence is small, and impotence is not nearly as
common as it is following prostate surgery.
Scientists at The Feinstein Institute are now
studying the effect of the radiation dose on long-term outcome.
Sarcosine is better indicator of advancing disease
than traditional prostate specific antigen test (PSA); it is detected in
urine, researchers hopeful simple urine test can be used
Aug. 4, 2009 - Men diagnosed with prostate cancer
have a number of treatments to choose from, but it's a daunting task to
figure out the right mix of therapies. Trends among medical
professionals have been to favor some treatments for younger men, and
others for older patients. A new study by scientists at The Feinstein
Institute for Medical Research and North Shore-LIJ Health System have
found that age doesn't make a difference in the long-term therapeutic
outcome.
