Juanita Crook and colleagues have provided a timely review of the use of brachytherapy in men with prostate cancer.1 We agree that permanent interstitial implants as monotherapy should be reserved for those with early-stage, localized prostate cancer. However, commentator Curtis Nickel was skeptical about the use of brachytherapy in such patients.2 We challenge the assertion that these patients represent a “small minority” of men found to have prostate cancer. In fact, with the advent of prostate-specific antigen screening, men are being diagnosed at a younger age with disease at an earlier stage than previously.3,4 On the basis of the available 10-year data, brachytherapy is an effective intervention for early-stage prostate cancer and is no longer considered experimental therapy.
It is unclear why Nickel characterizes the rates of side effects as “disturbing.” The most common one, irritative urinary symptoms, is generally self- limited. Impotence rates compare favourably with those following radical prostatectomy. This is part of the reason that patients are keen on being treated with brachytherapy. With the introduction of sophisticated technologies to further enhance the precision of the seed implant procedure, such approaches offer even greater promise for improved success rates, lower rates of side effects and an enhanced quality of life.5
Signatures
David D'Souza
Brachytherapy Fellow Department of Radiation Oncology Memorial Sloan-Kettering Cancer Center New York, NY
Michael J. Zelefsky
Chief of Brachytherapy Department of Radiation Oncology Memorial Sloan-Kettering Cancer Center New York, NY
References
- 1.Crook J, Lukka H, Klotz L, Bestic N, Johnston M, and the Genitourinary Cancer Disease Site Group of the Cancer Care Ontario Practice Guidelines Initiative. CMAJ 2001;164(7):975-81. [PMC free article] [PubMed]
- 2.Nickel JC. Brachytherapy for prostate cancer: Effective, but …? [editorial]. CMAJ 2001;164(7): 1011-2. [PMC free article] [PubMed]
- 3.Noldus J, Graefen M, Haese A, Henke RP, Hammerer P, Huland H. Stage migration in clinically localized prostate cancer. Eur Urol 2000;38:74-8. [DOI] [PubMed]
- 4.Jhaveri FM, Klein EA, Kupelian PA, Zippe C, Levin HS. Declining rates of extracapsular extension after radical prostatectomy: evidence for continued stage migration. J Clin Oncol 1999; 17:3167-72. [DOI] [PubMed]
- 5.Zelefsky MJ, Yamada Y, Cohen G, Venkatraman ES, Fung AY, Furhang E, Sivern D, Zaider M. Post implantation dosimetric analysis of permanent transperineal prostate implantation: improved dose distributions with an intraoperative computer-optimized conformal planning technique. Int J Radiat Oncol Biol Phys 2000;48(2):601-8. [DOI] [PubMed]