High Dose Rate Brachytherapy

Recently we reviewed a group of patients that I had treated between 1998 and 2000. We followed the patients up for a minimum of 10 years and compared it to a similar surgical series. Results were outstanding and in truth out-performed my surgical results in the very high-risk population by about 20% ( these results will shortly be the subject of a publication). It is worth noting, however, that surgery with follow up radiotherapy is challenging these results (see graph below).

Results of HDR

Generally, the cure-rate for high-dose rate brachytherapy in combination with external beam radiotherapy depends on how many high-risk factors ( Gleeson score 8-10 , PSA >20 , Clinical stage T3 )are involved. If there is:

  • One risk factor - 90% 10-year cure rate
  • Two risk factors - 70% Cure rate
  • Three risk factors - 60% Cure rate
  • Impotence - 50%
  • Incontinence - 1%
  • Rectal damage - <1%
  • Urethral stricture rate- 5%

Once again, high-dose brachytherapy is generally reserved for those patients with extremely extensive prostate cancer where surgical cure is difficult, particularly in more middle-aged and older patients, where urinary symptoms are not dominant and where there is a dominance of apical disease or where I am concerned that the cancer is not resectable.

 

About Phillip

Phillip is the Chairman of the Department of Urology, St Vincent's Private Hospital and Clinic since 2003, and a Director of the St Vincent's Prostate Cancer Centre.

The Australian Prostate Cancer Research Centre in New South Wales recently appointed him as clinical director. He is also a member of the National Prostate Cancer Research Centre

Philip is currently the highest volume robotic surgeon in Australasia

He is perhaps best known for his work developing nerve sparing techniques to help patients maximise potency