Canadian Medical Association Journal (CMAJ) 170(9) April 27, 2004
Juanita Cook, Himu Lukka, Laurence Klotz, Nancy Bestie, Mary Johnston and the Genitourniary Cancer Disease Site Group of the Cancer Care Ontario Practice Guidelines Initiative

Study purpose: Brachytherapy is a treatment in which “seeds” or pellets that emit radiation are implanted within the prostate to destroy a cancer. It helps treat prostate cancer that is too small to be seen via imaging technology, or is identifiable but hasn’t spread from the prostate (called T1 and T2 stage disease by physicians using TNM staging, a scale that measures the extent of tumours and goes up to stage T4). This study reviews the use of brachytherapy against these types of prostate cancers.

Study description: Internet databases were used to find studies from 1988 to 1999 that researched brachytherapy’s use against “localized” cancer within the prostate gland.

Findings: The literature reveals that less than 5% of patients have long-term complications after treatment. Complications include urinary incontinence, cystitis, and proctitis. Great difficulty in urinating freely was reported by 1NaV of patients. A large majority (86NaV) remained sexually active after radioactive “seeds” were implanted.

Conclusions: There is not enough evidence to recommend brachytherapy over standard therapies such as radiotherapy and radical prostatectomy (surgery to remove the prostate). However, because some patients had similar experiences to men who had radical prostatectomy, the authors feel brachytherapy should be made available. To qualify, men should have serum prostate-specific antigen (PSA) levels of 10 µg/L or less (high levels in PSA tests may indicate spreading cancer). They should also have a T1c stage tumour identified by a needle biopsy after increases in PSA levels or a T2a stage tumour that involves half a lobe of the prostate or less. Finally, brachytherapy patients should have a Gleason score of 6 or lower. This score classifies prostate cancer according to its agressiveness. Numbers up to ten indicate increasingly fast growing cancers.

Note: In the studies surveyed, the number of men who underwent brachytherapy and became disease-free varied widely. The authors believe differences in their condition largely depend on PSA levels before treatment and the type of tumour.

Last updated: March 21, 2007

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