Urology News


Prostate cancer guidelines on brachytherapy

In the current guidelines on prostate cancer, which were published in December 2016, the international data situation has now (finally) been accepted and a recommendation for primary curative treatment with brachytherapy for prostate cancer (PSA > 10 ng/ml or Gleason > 7 or tumour stage >pT2) has no longer been made.

This means that Germany has now also taken account of a development that had been in the offing since 2004.

The transperineal application of implants with iodine-125, radiation dose 145 Gy, or palladium-103, radiation dose 125 Gy, has spread rapidly since the mid-1990s, first in the USA, but then also in Europe and Germany. The reintroduction of the method is due to the new development of software for targeted insertion according to an implantation plan as well as to the improvement of transrectal ultrasound examination. Until 2004, the published results were also comparable with “radical prostatectomy”.

20 years after the introduction of brachytherapy for prostate cancer, there is still not a single randomised controlled study regarding its therapeutic effects in comparison with radical prostatectomy, percutaneous radiotherapy and/or against “watchful waiting” or “active surveillance”. Therefore, no reliable statements can be made about advantages or disadvantages or about the equivalence of this procedure compared to other therapy options.

This fact is in stark contrast to the full-bodied statements in the glossy brochures of some radiotherapy institutes.

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