Authors' objectives:

This report assesses the clinical effectiveness and cost effectiveness of prostate brachytherapy compared with radical prostatectomy, external beam radiation or watchful waiting.

Authors' recommendations: overall or cancer free survival: In most cases prostate cancer progress slowly; 5-year survival for localised prostate cancer is around 80%. None of the included studies had sufficient follow up for overall or disease free survival to allow for valid survival measures. In addition, overall survival was confounded by variation in age and comorbid conditions between the groups. Surrogate disease free survival (PSA-based): There was no difference between brachytherapy, external beam therapy or radical prostatectomy in disease free survival based on PSA-measures for a follow up of 5 years. Complications: There was no evidence from comparative studies that complications seen after brachytherapy were less than those seen after external beam radiotherapy or radical prostatectomy. Common complications after brachytherapy were urinary tract irritation, impotence and proctitis. Long term complications are not known. Quality of life: Two studies were included, but did not allow for any correlation as to quality of life between the treatment modalities. Organisational issues: Brachytherapy may be undertaken as an outpatient procedure, and should allow early recovery and rapid return to normal activities. External beam radiotherapy although an outpatient procedure, is normally given as 5 daily outpatient sessions for 7 weeks, which has consequences for patients living at some distance from the radiation facility. Thus patients living far from the hospital must either have rather extensive daily travelling or stay at or near the hospital during the treatment period. Radical prostatectomy requires hospitalisation, and patients in Norway are hospitalised for a median of 9 days (Norwegian Patient Registry). Low dose rate brachytherapy does not require special facilities other than dosimetric planning equipment, transrectal ultrasound and computer tomography. High dose rate brachytherapy requires a shielded room for the procedure and hospitalisation of the patient. Prostate brachytherapy requires cooperation between urologists, oncologists and radiation physicists. The urologist must be trained in transperinneal needle insertion and transrectal ultrasound. Ethical issues: The clinical effectiveness of brachytherapy is neither better nor worse than other prostate cancer interventions (we do not know how brachytherapy compare with "wait and see"). Although there were few studies describing patients treatment preferences, expectations for clinical effect and complications has been found to influence treatment choice. Preferences may be influenced by treatment characteristics (in-versus out patient, the need for operation etc.) and the availability of the actual treatment. Thus for some patients, especially those living far from hospitals providing external beam radiotherapy, the possibility of having a quick outpatient treatment may seem attractive. Legal issues: Brachytherapy is not offered to prostate cancer patients in Norway, which raises some legal questions. First of all the question of whether the doctors should inform patients of the possibility of having prostate brachytherapy, second whether the doctor should help to realise treatment in countries that provide it, and third is the question of whether costs for treatment abroad should be refunded. Patients deciding to have brachytherapy have to pay all costs, since brachytherapy is regarded as being experimental treatment.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.nokc.no/

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Norway

Organisation Name: Norwegian Institute of Public Health

Contact Address: Universitetsgata 2, Postbox 7004 St. Olavs plass, NO-0310 Oslo NORWAY. Tel: +47 23 25 50 00; Fax: +47 23 25 50 10;

Contact Name: Berit.Morland@nokc.no, dagny.fredheim@nokc.no

Contact Email: Berit.Morland@nokc.no, dagny.fredheim@nokc.no

Copyright: The Norwegian Knowledge Centre for the Health Services