Frequently asked questions
- What is the Prostate Brachytherapy Advisory Group?
- What is LDR brachytherapy?
- Which UK centres currently perform LDR brachytherapy?
- How does LDR brachytherapy compare with radical prostatectomy?
- Why did the Department of Health issue advice on the development of LDR brachytherapy services?
- What is the UK and Ireland Prostate Brachytherapy Group
- What guidance is available on the commissioning/implementation of LDR brachytherapy services in order to meet Department of Health recommendations?
- What is the cost of performing LDR brachytherapy?
- Who are the leading suppliers of brachytherapy seeds?
The Prostate Brachytherapy Advisory Group is an independent group of medical and NHS representatives with an active interest in brachytherapy and commissioning of services. It is dedicated to supporting universal access to high-quality prostate brachytherapy in the UK through:
- supporting the development of brachytherapy services nationally, and improving patient coverage by PCTs in line with Department of Health (DH) guidelines
- optimising the use of services within radiotherapy centres currently performing brachytherapy including the commissioning of brachytherapy services by PCTs in areas without a local provider
- promoting best practice and evidence-based approaches taken from UK and centres of excellence
- improving the prostate cancer patient journey by increasing the understanding of patients and helping them make informed treatment choices.
Brachytherapy is an increasingly popular alternative to radical surgery and radiotherapy for many patients with early, localised prostate cancer. It involves the transperineal placement of radioactive seeds directly into the prostate under ultrasound guidance and aims to deliver a high dose of radiation to the prostate (145 Gy). Many patients experience no immediate morbidity and can work or travel as they please. Brachytherapy has, therefore, become a very attractive option for those seeking to minimise the inconvenience associated with other radical treatments.
Centres performing LDR brachytherapy in the UK and Ireland are shown below.
Survival after brachytherapy compares very favourably with that after radical prostatectomy, as shown by Table 9.
Table 9 Ten-year cause-specific survival: comparison of radical prostatectomy (RP) vs seeds 1
| Series | Year | Treatment | All (%) | Low-grade (%) | Intermediate-grade (%) |
|---|---|---|---|---|---|
| Zinke | 1994 | RP | 90 | 95 | 90 |
| Iselin | 1999 | RP | 87 | 85 | |
| Hull | 2000 | RP | 97 | ||
| Gerber | 1996 | RP | 85 | 94 | 80 |
| Beyer | 2003 | Seeds | 87 | 91 | 92 |
- Prostate cancer is now the most common cancer in men in England.
- With an ageing population, an increased public awareness of symptoms and increased use of the prostate-specific antigen (PSA) blood test, it is likely that there will be more cases of prostate cancer picked up at an early stage (localised).
- Speed, convenience, favourable toxicity and effectiveness of brachytherapy are leading to increased demand from patients for this form of treatment.
- NICE published guidance on Low dose-rate brachytherapy for localised prostate cancer (July 2005) recommending that it is safe and efficacious enough for routine use in the NHS. NICE will also produce a clinical guideline on the diagnosis and treatment of prostate cancer (2008), which should bring some further clarity about the optimum form of management for prostate cancer patients.
- NICE's recommendations are likely to lead to even more demand for brachytherapy from patients. There is therefore a danger of unplanned growth in service provision to meet this demand. Consequently the DH wants to manage the provision of brachytherapy services in order to maintain the highest quality of care while ensuring equalities in patient access to this treatment, regardless of geography.
This is a national group of healthcare professionals (physicians, nurses, and medical physics) from UK and allied international centres performing brachytherapy who meet on an annual basis to discuss short- and long-term outcomes data associated with the routine use of brachytherapy, and review clinical and patient developments. Presentations from the most recent meeting are located in Section 4.2
What guidance is available on the commissioning/implementation of LDR brachytherapy services in order to meet Department of Health recommendations?
In order to meet DH recommendations and service levels for the commissioning and provision of brachytherapy, 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. It is felt that these 10+ centres would be able to meet the increased service levels outlined by the DH and provide the highest quality care.
Recently published results of a French multicenter prospective medico-economic study (see Key publications, Health economic data) calculated the cost to society of LDR brachytherapy after 2 years as 8,019 Euros, compared to 8,715 Euros for radical prostatectomy over the same period.
The Prostate Brachytherapy Advisory Group has also commissioned a new health economic report from the York Health Economics Consortium at the University of York, due to be published later this year.
Table 10 Suppliers of brachytherapy seeds (ranked according to number of patients treated)
| Supplier | Website |
|---|---|
| Oncura | www.oncura.com |
| Eckert & Ziegler BEBIG GmbH | www.bebig.com |
| Bard Inc. | www.bardurological.com |
| IBt | brachytherapy.nexenservices.com |
References
1: Beyer DC, Thomas T, Hilbe J, Swenson V. Relative influence of Gleason score and pretreatment PSA in predicting survival following brachytherapy for prostate cancer. Brachytherapy 2003;2:77-84.
2: Hummel S, Paisley S, Morgan A, Currie E, Brewer N. Clinical and cost-effectiveness of new and emerging technologies for early localised prostate cancer: a systematic review. Health Technol Assess 2003;7(33):iii, ix-x, 1-157.
3: Wilson LS, Tesoro R, Elkin EP, et al. Cumulative cost pattern comparison of prostate cancer treatments. Cancer 2007;109:518-27