Brachytherapy commissioning tools
Brachytherapy commissioning tools
PowerPoint presentations and other document templates are provided in this section. It is hoped that these will help speed and streamline the commissioning of care process for brachytherapy services based on the following decision-making flow. Information contained in other sections of prostatebrachytherapyinfo.net and links to additional sources of information are indicated.
Factors considered by the Prostate Cancer Advisory Group include:
- guidance/recommendations from DH and NICE
- long-term outcomes
- patient benefits
- cost of care.
Guidance/recommendations from DH and NICE
In order to best implement the DH advice and meet future service levels, the Prostate Brachytherapy Advisory Group recommends that it would be most effective to concentrate efforts on and commission services from the restricted number of centres that are already up and running and undertaking 25+ procedures per year, and to develop the highest-quality services in these centres. See 'Brachytherapy guidance and guidelines' section and 'UK brachytherapy centres' section for detailed information and data from each centre.
Long-term outcomes
A number of recent papers have been published reporting PSA progression-free survival for patients with intermediate-/high-risk prostate cancer treated with seed implant/EBRT combined treatment. The findings are summarised in Table 7.
Table 7 PSA progression-free survival
| Series | Year | No of patients | PSA failure definition | Follow-up years | PSA progression-free survival intermediate/high risk (%) |
|---|---|---|---|---|---|
| Sylvester et al1 | 2007 | 223 | ASTRO modified to two rises | 15 | 80 / 67 |
| Critz et al2 | 2004 | 1469 | PSA <0.2ng/ml | 10 | 80 / 61 |
For survival data from UK centres of excellence, refer to individual entries in the section 'UK brachytherapy centres'
Patient benefits
Increasingly, healthcare professionals are becoming conscious of quality-of-life issues relating to treatment. The attached mini-review looks at this important issue, illustrating that patients often want to choose a treatment that will more certainly guarantee a better quality of life.
Studies have shown that prostate brachytherapy impacts less on patient quality of life than other treatment options (incontinence and sexual dysfunction). Longer-term data suggest that brachytherapy is a well-tolerated treatment for localised prostate cancer.
Health-related quality of life after prostate brachytherapy
Cost of care
Interstitial brachytherapy and radical prostatectomy are effective treatments for localised prostate cancer with similar cost profiles, but different long-term side-effects, according to the results of a new multicentre study in France (see document below).
'This study is exciting because it's the first time we have a comparative study to assess the costs in a given country and are able to see if the side-effects are different for patients who received surgery or brachytherapy', study co-author Dr Jean-Marc Cosset, from the Institut Curie in Paris, said in a statement.
The study involved 435 men with localised disease who were treated with brachytherapy or prostatectomy and completed quality-of-life and symptom questionnaires immediately after treatment and at 2, 6, 12, 18, and 24 months. A comparative cost analysis, which covered initial therapy, hospital follow-up, outpatient and production-loss costs, was also performed.
The researchers' findings appear in the International Journal of Radiation Oncology, Biology and Physics and can be accessed using the link below.
The drop in health-related quality of life immediately after treatment was less pronounced in the brachytherapy group compared with the prostatectomy group (P < 0.0001). However, from 6 to 24 months prostatectomy was associated with a better quality of life (P < 0.05).
Impotence and urinary incontinence were more likely with prostatectomy, whereas urinary frequency, urgency, and pain were more common with brachytherapy.
As noted, the cumulative costs of each treatment were comparable at 24 months — 8019 Euros for brachytherapy and 8715 Euros for prostatectomy.
These 'findings may be used to tailor localized prostate cancer treatments to suit individual patients' needs', the researchers conclude.
Results of a French mulitcenter prospective medico-economic study.
The findings of this research are supported by a second recently published study from the US which tracked costs over time, optimising the accuracy of the cost of illness, and performed a cost-effectiveness analysis (see Table 8 and link below).
Table 8 — Accumulated mean prostate cancer-related costs by cost category, primary treatment, and risk factor 5
| Medication costs, $ | Office visit costs, $ | Hospitalization costs, $ | Total all costs, $ | Total, $ | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary Treatment | Low Risk | Med. Risk | High risk | Low Risk | Med. Risk | High risk | Low Risk | Med. Risk | High risk | Low Risk | Med. risk | High risk | All risk |
| Brachytherapy | 3741 (316) | 4940 (213) | 9050 (99) | 18,844 | 23,873 | 24,153 | 5780 | 12,605 | 9832 | 28,366 | 41,419 | 43,035 | 35,143 |
| Radical prostatectomy | 2832 (1,124) | 6869 (856) | 19,781 (375) | 18,116 | 18,180 | 24,085 | 11,847 | 9989 | 10,188 | 32,795 | 35,037 | 54,055 | 36,888 |
| External beam radiation | 6615 (106) | 9164 (146) | 23,195 (145) | 36,446 | 43,327 | 40,874 | 5879 | 4234 | 8668 | 48,840 | 56,725 | 72,737 | 59,455 |
| Androgen deprivation therapy | 14,261 (120) | 20,905 (150) | 50,632 (309) | 26,236 | 30,155 | 30,884 | 4599 | 5682 | 6007 | 45,095 | 56,738 | 87,523 | 69,244 |
| Cryotherapy | 7768 (36) | 3346 (38) | 25,697 (57) | 17,533 | 21,912 | 20,756 | 6,301 | 7555 | 7288 | 31,602 | 32,814 | 53,741 | 43,108 |
| Watchful waiting | 5269 (127) | 5098 (51) | 4854 (33) | 19,716 | 21,757 | 20,235 | 6886 | 4934 | 1795 | 31,871 | 31,789 | 26,884 | 32,135 |
| All treatments | 4154 (1829) | 8329 (1454) | 28,138 (1018) | 19,875 | 22,775 | 28,268 | 9564 | 8777 | 8086 | 33,593 | 39,882 | 64,491 | 42,570 |
| Total all treatments | 10,932 | 22,721 | 8917 | 42,570 | |||||||||
| Data in parentheses are MCE mean cumulative function cost. | |||||||||||||
Cumulative Cost Pattern Comparison of Prostate Cancer Treatments.
Executive report
The following document summarises relevant information in the form of an executive report.
Low dose-rate brachytherapy
References
1: Sylvester JE, Grimm PD, Blasko JC et al. 15-Year biochemical relapse free survival in clinical Stage T1—T3 prostate cancer following combined external beam radiotherapy and brachytherapy; Seattle experience. Int J Radiat Oncol Biol Phys 2007;67:57—64.
2: Critz FA, Levinson K. 10-year disease-free survival rates after simultaneous irradiation for prostate cancer with a focus on calculation methodology. J Urol 2004;172:2232—8.
3: Merrick GS, Butler WM, Wallner KE, Galbreath RW, Adamovich E. Permanent interstitial brachytherapy for clinically organ-confined high-grade prostate cancer with a pretreatment PSA < 20 ng/mL. Am J Clin Oncol 2004;27:611—15.
4: Stock RG, Cahlon O, Cesaretti JA, Kollmeier MA, Stone NN. Combined modality treatment in the management of high-risk prostate cancer. Int J Radiat Oncol Biol Phys 2004;59:1352—9.
5: Wilson LS, Tesoro R, Elkin EP, et al. Cumulative cost pattern comparison of prostate cancer treatments. Cancer 2007;109:518—27