Authors' objectives:

To assess the available evidence on the effectiveness of brachytherapy for prostate cancer.

Authors' results and conclusions: The state of scientific knowledge of this therapy, its efficacy, effectiveness and clinical safety are difficult to assess, since the search performed in the literature unearthed no randomised and controlled clinical trials. The numerous studies carried out assessing the technique are limited to observational studies, most of them retrospective, plus a small number of clinical series with non-equivalent comparison groups (without randomised grouping). Moreover, they present great variability in patient recruitment criteria (age, comorbidities, socio-economic class), characteristics of the tumour (staging, Gleason, PSA), implantation of different seeds and techniques, combination of treatments, follow-up time and different definition of the progression of the disease.

Authors' recommendations: The intermediate short-term results of brachytherapy (biochemical control levels and disease-free survival) for patients selected with a low risk of extraprostatic progression seem to be comparable to those of other therapeutic options, such as prostatectomy and external radiotherapy. There are no long-term data available, despite the fact that the results of a sample (n=77) followed up for 12 years were recently published, with the same rate of disease-free survival as was observed after 10 years of follow-up (66%). Amongst the complications secondary to brachytherapy described are prostatitis and acute urethritis with greater frequency than after surgery, whereas impotence and urinary incontinence are also found in a smaller proportion. Brachytherapy seems to be indicated for patients with a low risk of extracapsular extension (stagings T1, T2a; clearly differentiated and with low pretreatment rates of AST) with patients presenting prior irradiation of the pelvis, severe urethral obstruction and transurethral prostatic resection excluded. There is uncertainty with regard to localised prostate cancer (PC). Despite the fact that there is evidence that this type of tumour tends to present a slow progression, it is not clear whether the type of treatment will or will not help all men with PC to live longer. On the other hand it must be remembered that treatments can affect patient quality of life. Thus, random-design clinical trials are needed with long follow-ups to confirm the efficacy and safety of brachytherapy, assess patient quality of life and define the role of this technique in the treatment of PC. In view of the lack of a therapeutical alternative that is clearly better than the rest, and of the existence of major side effects of some therapeutic options, it is becoming increasingly more necessary to consider the values and the preferences of patients in the approach to this clinical condition.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.gencat.net/salut/depsan/units/aatrm/html/en/dir393/doc7921.ht ml

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Qualitat i Avaluacio Sanitries de Catalunya

Contact Address: Antoni Parada, CAHTA, Roc Boronat, 81-95 (2nd floor), 08005 Barcelona, Spain, Tel. +34 935 513 928, Fax: +34 935 517 510

Contact Name: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Contact Email: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Copyright: Catalan Agency for Health Technology Assessment and Research (CAHTA)