Revisiting a High-risk Prostate Cancer Treatment

Physicians have always assumed that implanting radioactive “seeds” (brachytherapy) to treat high-risk prostate cancer is less effective than external beam radiation therapy (EBRT).  But a new study of 13,000 prostate cancer patients, done at Philadelphia’s Kimmel Cancer Center at Thomas Jefferson University, suggests otherwise.

A prostate cancer’s degree of risk depends on its Gleason Score (a number that rates how aggressive its cells are) and how far the disease cells have spread. The study revealed that men with high-risk malignancies who received brachytherapy, in which the seeds are placed directly at the tumor site, had significantly reduced mortality rates.

In the study, patients treated with brachytherapy alone or with brachytherapy plus EBRT showed a significant reduction in prostate cancer mortality, compared to those treated only with EBRT.
It now appears that in the past, attempts to use radioactive seeds may have suffered from poor technique and that today’s higher quality brachytherapy may in fact be an effective tool against high-risk prostate cancer.

Currently, physicians are not recommending brachytherapy for high-risk patients, but lead study author Xinglei Shen, M.D., of Jefferson’s Department of Radiation Oncology, thinks that may change. “If you look at the biology and theory behind it, it makes sense,” he says. “You can really give a lot more dosage with brachytherapy than with EBRT alone to the prostate. And this presents an opportunity for high-risk patients.”