This year marks the NHS’ 70th birthday and naturally, we’re reflecting on how much the healthcare sector has evolved. We’ve watched the NHS grow and have seen huge breakthroughs in medicine. Theresa May’s recent announcement of a £75m investment to drive prostate cancer research not only shines a light on how far the treatment pathway for prostate cancer (PCa) has come, but also how far it has left to go.

A brief history of LDR brachytherapy

Brachytherapy was first used in 1901, pioneered at the Curie Institute in Paris by Henri-Alexandre Danlos, a French doctor, who originally tested that radioactivity could be used to treat cancer. In the years after, a number of doctors pioneered the technology’s application in treating a variety of different cancers such as Hugh Hampton Young and Benjamin Barringer in the field of prostate cancer. In the 1990s imaging technologies emerged such as MRI and CT scans which help doctors plan a brachytherapy procedure.

As brachytherapy has advanced so too has its application and its applicability, affording a wide variety of patients optimum outcomes with minimal side effects, whilst also proving a more economically viable procedure for clinicians and hospital managers.

Implant Techniques: 4D Brachytherapy

At the turn of the century, advanced computerised brachytherapy planning techniques were introduced. 4D Brachytherapy™, a one-stage implant technique, uses a combination of pre-loaded stranded seeds around the periphery of the prostate gland and seeds optimally placed within the centre. Through this technique, surgeons can calculate the number of seeds required prior to the implant procedure, with the use of a simple web-based scan which takes five key measurements of the prostate. This combination technique provides technicians with speed and accuracy, resulting in reduced operating times and less need for a general anaesthetic.

Unfavourable PCa?

Some healthcare professionals have indicated that LDR-B is a treatment option only relevant for those patients with low-risk prostate cancer, however, the ASCENDE-RT study has revealed otherwise. The study found that LDR-B boost in combination with EBRT is far superior when compared to dose-escalated EBRT alone. Moreover, the first randomised controlled trial, ASCENDE-RT provided evidence that revealed clear advantages in better overall survival for men with unfavourable-risk PCa – ie. those with intermediate and high-risk. LDR-B also offers lower incidence of severe side-effects, such as impaired sexual function and incontinence, which are common occurrences with other procedures such as Radical Prostatectomy (RP) and External Beam Radiation Therapy (EBRT).

But what about recurrence?

Historically, there’s a perception that patients who decide to opt for LDR-B cannot have salvage treatment at a later stage. This isn’t true. The reality is, should recurrence happen, surgery is still a distinct possibility even if a patient has had LDR-B. Patients can still consider further brachytherapy options such as a top-up LDR-B implant, High Dose Rate brachytherapy and hormone treatment.