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March 2010: Hear from men treated for prostate cancer, and their partners, talking about their fears of the impact of treatment on their sex-life, and their positive experiences with prostate brachytherapy...
click here to view the 'Prostate Brachytherapy....because relationships matter' video (opens in new window)
London, April 8 /PRNewswire/ - The Prostate Brachytherapy Advisory Group has released a video entitled Prostate Brachytherapy....because relationships matter' to highlight the impact that treatment choice may have on relationships.
The video follows three men, diagnosed with localised prostate cancer in their late forties and their early 50s, who have had to face life-changing decisions. All three men opted for prostate brachytherapy, a minimally invasive procedure which has the same high cure rate as surgery, but less risk of impotence and incontinence. (1)
The video highlights the importance of access to reliable information on treatment options and their side effects, and the impact that treatment choice may have on relationships, in particular, sexual function.
As Graham Robson, one of the men featured in the film, explains. "I was separated when I was diagnosed with prostate cancer, but I was hoping to be in a relationship again soon. My doctor advised me to have surgery and warned me that I may be left impotent and incontinent. At the time, I was just focused on staying alive and, if that meant that I would not be able to have sex again, then that was the price to pay. So when I heard about prostate brachytherapy, the relief was incredible. I mean, when exactly would you tell a new girlfriend that you were impotent - on the first date?"
"Being diagnosed with prostate cancer is extremely traumatic and often the first reaction of many men and, indeed, many doctors, is to have a radical prostatectomy to remove the prostate," comments Professor Stephen Langley, Chair of the Prostate Brachytherapy Advisory Group and Professor of Urology at St Luke's Cancer Centre, Guildford. "For some men, this may be the best option, but for those with localised prostate cancer then prostate brachytherapy is a very effective treatment."
Prostate brachytherapy is usually performed as a day case procedure and most patients go home the same or following day and return to work a few days later. The treatment involves implanting tiny radioactive seeds, under general anesthetic, directly into the prostate gland using fine needles.
Explains Rick Popert, Consultant Urologist, Guy's & St Thomas' NHS Foundation Trust, "Patients are often unaware that radical prostatectomy is still a major operation and, even with the latest techniques, nerve damage can occur. This, unfortunately, can leave a man impotent and incontinent, which may recover over time, but equally may not."
January 2010: ICER publish Management Options for Low-Risk Prostate Cancer: A Report on Comparative Effectiveness and Value. Prostate brachytherapy found to be of 'high value' - less costly and more effective than reference strategy.
The Institute for Clinical and Economic Review (ICER),is an independent research and policy group based at the Massachusetts General Hospital’s Institute for Technology Assessment (ITA). It provides independent evaluation of the comparative clinical effectiveness and comparative value of new and emerging technologies.
The latest prostate cancer review represents a summary of three prior technology appraisals of management options for clinically-localised, low-risk prostate cancer published between November 2007 – September 2009:
ICER presented a systematic review of published evidence on the treatment of low-risk prostate cancer as well as simulation modelling to project the long-term effects of each treatment approach. The evidence on radical prostatectomy, brachytherapy, and IMRT was judged to demonstrate comparable overall clinical effectiveness for most men although important quality-of-life differences are noted.
The ICER model calculates the lifetime cost per quality-adjusted life-year (QALY) gained. Of the definitive treatments examined (surgery, brachytherapy and IMRT) brachytherapy was found to be the most effective form of treatment according to the model. Using radical prostatectomy as the reference strategy, brachytherapy was found to save nearly $3,000 per QALY whilst other radiation treatments were associated with higher costs than surgery. Taking into account cure rate, quality of life and cost factors, brachytherapy emerged as a cost-saving alternative to radical prostatectomy and was deemed to be the only ‘high value’ definitive treatment alternative.
Lifetime quality-adjusted life expectancy and costs for 65-year-old men with clinically-localised, low-risk prostate cancer, by treatment type
|
Strategy |
QALYs |
Incremental QALYs |
Cost |
Incremental cost |
Cost/QALY |
|
AS |
8.97 |
1.15 |
$30,422 |
$2,074 |
$1,803 |
|
Brachytherapy |
8.12 |
0.30 |
$25,484 |
($2,864) |
N/A † |
|
IMRT |
8.09 |
0.27 |
$37,861 |
$9,513 |
$35,233* |
|
Proton Beam |
7.97 |
0.15 |
$53,828 |
$25,480 |
$169,867* |
|
RP |
7.82 |
Reference |
$28,348 |
Reference |
|
|
NOTES: |
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Reference:
Ollendorf DA, Hayes J, McMahon P et al. Management options for low-risk prostate cancer: a report on comparative effectiveness and value. Boston, MA: Institute for Clinical and Economic Review, December 2009. Available at:
http://www.icer-review.org/index.php/mgmtoptionlrpc.html
December 2009: Shocking variations in cancer survival reported in different parts of UK.
The second annual report of the Cancer Reform Strategy, headed by Professor Mike Richards, set out the progress made in implementing the Strategy since its inception in December 2007. Covering a wide range of actions and targets, some startling statistics were revealed.
One-year survival for breast, colorectal and lung cancers broken out by Primary Care Trust (PCT) show a wide variation for different parts of the UK. On average, 94.9% of breast cancer patients are alive after one year, but this ranged between 89.3% in Tower Hamlets to 99% in Torbay. Colorectal cancer showed a big gap between the best and worst – from 80% in Telford and Wrekin, but only 57.9% in Waltham Forest, with the average being 70.7%. The most striking difference related to lung cancer patients, where survival ranged from 15.4% in Herefordshire up to 43.7% in Kensington and Chelsea. The international ‘good practice’ level is 37% or higher but only Kensington and Chelsea PCT achieved this. The UK average one-year lung cancer survival rate is just 28.1%.
The number of prostate cancer patients alive at least one year after diagnosis ranged between 84.1 – 92.9% (individual PCTs not identified).
The data prompted shocked comment from Harpal Kumar, chief executive of Cancer Research UK. “It is appalling that someone with lung cancer in Herefordshire should be three times more likely to die within a year than a patient in Kensington, or that a person diagnosed with bowel cancer in Waltham Forest or Hastings should be 22% more likely to die within a year than a patient in Telford. This is the worst kind of postcode lottery.”
Overall, cancer deaths continue to fall and prevention efforts, vaccination and better screening, should help further. The report identified earlier diagnosis of cancer as being a key factor in achieving fewer cancer deaths, raising questions about inequalities in the provision of care and highlighting the need to raise awareness among potential cancer patients and their GPs.
Full report available from Department of Health website.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_109338