Clinical opinions / 14 Sep, 2020

Focal brachytherapy: Personalised care for prostate cancer

Dr Andrew See & A/Prof Jeremy Grummet

16 700 Australian men are diagnosed with prostate cancer annually.

Some men with prostate cancer may not require any treatment, yet still live a normal lifespan and eventually pass away from other causes. Others, diagnosed too late with an aggressive form of prostate cancer, will eventually die from the disease. However, for men who are diagnosed early with more aggressive disease, prostate cancer can be cured with treatment.

Despite the emotional upheaval that can be triggered by a cancer diagnosis, prostate cancer is rarely ‘imminently’ life-threatening. This gives you the time and opportunity to consider your personal choice and preference for treatment, and to talk with your doctor who will map out a considered management path that best fits your cancer.

The latest in prostate cancer diagnosis and treatment

Surgery or radiation therapy are the two main options available for men who have prostate cancer which requires treatment.

Although improvements with both options have led to a reduction in harmful side effects, your doctor will discuss with you the impact these treatments may have on erectile, bladder and bowel function.

We are lucky to now have access to a number of advanced imaging technologies which are used by urologists to diagnose prostate cancer with greater accuracy, including multi-parametric MRI and PSMA PET scanning, alongside the introduction of targeted trans-perineal (skin behind the scrotum and anus) prostate biopsy.

These cutting-edge technologies have helped facilitate an unprecedented understanding of the specific location(s) of the cancer within the prostate, which means doctors can now ‘focally’ treat just the diseased region rather than removing or ablating the entire organ. For men with prostate cancer, this approach can reduce treatment-related side effects and improve survivorship whilst curing your prostate cancer.

When you look at the history of cancer treatment, there are many other examples of preservation strategies and techniques which have revolutionised cancer care. Previously, the only treatment option available for women with breast cancer was mastectomy or removal of the entire breast. Now, with the option of a lumpectomy (removal of the cancerous part of the breast), many women no longer need to face significant surgery and the emotional and physical impact this can have.

What is focal brachytherapy?

Focal low dose rate brachytherapy (aka Focal Seed Brachytherapy) involves the implantation of small seeds, usually around 14-30, directly into the cancerous area of the prostate. The seeds are radioactive for three months during which time the cancer is destroyed.

Whole gland seed brachytherapy has been available for over 40 years and is supported by a considerable body of evidence attesting to its long term-safety and efficacy. Focal brachytherapy uses the same technique, however is a highly targeted technique which preserves the rest of the prostate gland.

LIBERATE clinical registry

LIBERATE is a prospective registry study that is recruiting men with clinically localised low to intermediate risk prostate cancer who undergo focal brachytherapy. To be eligible, your tumour must be confined to only one small area of the prostate.

The LIBERATE clinical registry will monitor men who have undergone focal brachytherapy for prostate cancer to determine the effects of treatment on long term quality of life and rates of cancer control. For more information on the LIBERATE clinical registry, click here.

By Dr Andrew See, Radiation Oncologist and A/Professor Jeremy Grummet, Urologist for the LIBERATE Management Committee, Icon Cancer Centre Epworth Richmond and Freemasons.

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