Focus on Focal Therapy – for the treatment of prostate cancer
A rising general consensus amongst consultants of the need for more targeted, localised treatment plans for prostate cancer, has in places led to focal therapy gaining ground with treatments like High-Intensity Focused Ultrasound (HIFU). However, in a cash-strapped NHS, HIFU is an expensive unproven option. The lack of long-term clinical efficacy – even in low-risk favourable patients – means that the treatment is not NICE approved and procedures should only be used with special arrangements for clinical governance, consent and audit or research. Even more alarming, a recent study – as published by the American Urological Association – found that only 73% of a mostly favourable risk cohort of men given this treatment were failure-free survival at two years. As Assistant Professor Ashwin Shinde, Department of Radiation Oncology at Vanderbilt University Medical Center, commented: “When do we stop this madness?”
Low Dose Rate Brachytherapy (LDR-B), however, is a well evidenced, NICE approved therapy that can offer an effective alternative to radical prostatectomy and less proven focal therapies like HIFU and Cryotherapy.
A form of internal radiotherapy, LDR-B involves inserting permanent radioactive seeds into the prostate gland. This process allows surgeons to accurately target the site of a tumour, avoiding damage to the healthy cells surrounding it and is a natural choice for focal therapy approaches. The direct and non-complicated nature of the procedure results in faster recovery times and lower complication rates than radical surgical options, which are all too often offered as the first port of call to patients.
Studies have revealed that LDR-B provides better quality of life outcomes when compared to patients being treated with radical prostatectomy. A study published in September 2017, titled: ‘Quality of life after brachytherapy or bilateral nerve‐sparing robot‐assisted radical prostatectomy for prostate cancer: a prospective cohort’, compared patient quality of life after either brachytherapy or radical prostatectomy treatments. The study revealed that during six years post-treatment patients who underwent brachytherapy had significantly higher quality of life scores, overall at 1,2 and 3 years after treatment. Better scores equate to better function post-treatment.
Additionally, further studies reveal that a monotherapy implant technique – ‘4D brachytherapy’ – offers cost benefits of over 40% in comparison to traditional two-stage approaches. Medical innovation and advancement should be welcomed and encouraged. Developments in using targeted, localised treatment options to improve patient outcomes and minimise unwanted side effects is critical. However, medical professionals need to give equal credence to the proven and cost-effective treatments for prostate cancer, such as LDR-B, that can deliver positive outcomes for patients.
Saheed Rashid, Director General de BXTAccelyon
HEALTH TECHNOLOGY ASSESSMENT VOLUME 19 ISSUE 49 JULY 2015 ISSN 1366-5278 DOI 10.3310/hta19490 Ablative therapy for people with localised prostate cancer: a systematic review and economic evaluation Craig R Ramsay, Temitope E Adewuyi, Joanne Gray, Jenni Hislop, Mark DF Shirley, Shalmini Jayakody, Graeme MacLennan, Cynthia Fraser, Sara MacLennan, Miriam Brazzelli, James N’Dow, Robert Pickard, Clare Robertson, Kieran Rothnie, Stephen P Rushton, Luke Vale and Thomas B LamManagement Options for Low-Risk Prostate Cancer: A Report on Comparative Effectiveness and Value’, ICER 2009.