Brachytherapy Offers Early-Stage Prostate Cancer Patients High QOL

ORLANDO—Permanent trans-peritoneal ultrasound-guided radioactive implants (brachytherapy) get high marks for quality of life (QOL) in men with clinically localized prostate cancer, V. Elayne Arterbery, MD, reported in a poster session at the annual meeting of the American Society of Therapeutic Radiology and Oncology (ASTRO).

“Although survival is an important goal in treatment for prostate cancer,” she said, “the nature of this malignancy really compels the clinician to pay attention to the patient’s quality of life,” including ability to return to work quickly, maintain a social life, and maintain sexual function.

Dr. Arterbery, director of the Crittenton DMC Radiation Oncology Center and associate professor, Wayne State University, Rochester, Michigan, surveyed 51 consecutive patients with clinically localized prostate cancer who underwent prostate brachytherapy from September 1995 to October 1996.

While acknowledging that the short follow-up does not allow for definitive statements about efficacy, Dr. Arterbery said that “at this point, we really just wanted to know how patients were doing 6 months after their initial treatment.”

The survey showed that 87% of the men were sexually potent 6 months after the implant. Potency was defined as being able to maintain an erection sufficient for intercourse. Of those patients reporting sexual potency, 74% said that their desire to have sex was the same as before the implant.

All of the 51 patients studied had clinically localized prostate cancer, at stage T1c or T2b. They had received either iodine-125 or palladium-103 seed implants.

The 6-month data were collected using the EORTC Genitourinary Group questionnaire as well as supplemental questions. The latter focused on lifestyle changes and the patients’ ability to work, as well as post-implant sequelae and urinary and rectal symptoms.

Dr. Arterbery also inquired as to how the patients rated their quality of life post-implant and if they would recommend the procedure to a friend. The questionnaires were given to each patient individually, and she said there was a 95% rate of compliance.

More Frequent Urination

At 6 months, 40% of the patients reported that they urinated more frequently than before the brachytherapy, and 17% said they had mild pain or burning upon urination. None of the patients reported hematuria, and only 3% had any difficulty controlling urinary flow.

Only 3% of the men felt that their symptoms disrupted their family life, and none reported any psychological distress.

Post-implant, most of the men (93%) said they took alpha blockers for 6 weeks, and 75% felt that the drugs improved their symptoms.

One of the most important quality of life factors, Dr. Arterbery said, was the patients’ quick return to work. “Most of these patients returned to work within 3 days,” she said. “They really don’t lose economic viability, and this is certainly a big issue here in Michigan where many of our patients work for GM or Chrysler.”

She said that being able to have a procedure that does not disrupt work schedules is “a very important decision-making factor for most patients in selecting treatment.”

While there are a number of different treatments for prostate cancer, including surgery and external beam radiation therapy, Dr. Arterbery feels that seed implants are effective for clinically localized prostate cancer, and the low morbidity as well as the quality of life associated with the procedure make it a viable treatment option.