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Medical Experts Demand Better Access to Treatment for Prostate Cancer Patients

19 June 2007, Glasgow: A group of leading healthcare professionals – The Prostate Brachytherapy Advisory Group - has called today for the eradication of the postcode lottery system for prostate cancer patients seeking a form of treatment known as low dose rate (LDR) brachytherapy. Currently, 1 in 6 patients are denied access to this proven therapy1 despite the fact that the National Institute of Health and Clinical Excellence (NICE) has approved LDR brachytherapy2 and the Department of Health has issued advice supporting increased usage.3

Prostate cancer is the most commonly diagnosed cancer in men and accounts for more than 10,000 deaths each year, yet men with prostate cancer report having a significantly worse experience of treatment and care than patients with other cancers.4

LDR brachytherapy (seed implantation) is a form of targeted radiotherapy for localised prostate cancer. Unlike surgery, it is minimally invasive and involves implanting tiny radioactive seeds through fine needles into the prostate to destroy the cancer cells. The procedure normally takes less than an hour to perform under anaesthia and most patients can go home the next day with minimal disruption to their day-to-day life.

Studies show that brachytherapy is a proven and well-tolerated therapy. The 10-year cancer free rates following LDR brachytherapy is similar to that with conventional beam radiotherapy and surgery (radical prostatectomy). Reported rates vary between 66% and 92% depending on the initial severity of the disease2, but this is achieved with a lower risk of the complications associated with surgery and conventional beam radiotherapy.

Indeed, LDR brachytherapy scored highest in a recently published health related quality of life (HRQoL) study. Data collected from 625 patients through self completed questionnaires following treatment indicated urinary incontinence scores of 85.9, 85.5 and 73.4 (for LDR brachytherapy, external beam radiation and radical prostatectomy),
with higher scores indicating more favourable HRQoL outcomes. Similarly, LDR brachytherapy scored best with regard to preservation of sexual function following treatment. Mean scores of 37.8, 28.0 and 25.1 for LDR brachytherapy, external beam radiation and radical prostatectomy were recorded.5

Recently, 15-year survival figures have been published for men who received brachytherapy combined with external beam radiotherapy for the treatment of localised prostate cancer. The overall PSA progression-free survival rate in 223 patients at 15 years was 80% in intermediate risk patients.6

The key objective of The Prostate Brachytherapy Advisory Group is to support the development of brachytherapy services nationally in line with the Department of Health expectations4 and to improve patient coverage by Primary Care Trusts (PCT) through educational initiatives. The Group, which was formed in March 2007, consists of medical and NHS representatives with an active interest in the commissioning of services and the provision of care for LDR brachytherapy patients.

Stephen Langley, Professor of Urology at St Luke’s Cancer Centre, Guildford, is Chair of the Group and a leading expert in the field. “There is a clear disparity in the provision of LDR brachytherapy for prostate patients across the UK,” says Professor Langley. “We are calling on healthcare purchasers and providers to improve access to LDR brachytherapy by four-fold in line with Government expectations and patient choice; to create a better understanding of LDR brachytherapy amongst healthcare commissioners; and to empower patients to make an informed choice.”

To help the commissioning of LDR brachytherapy services, The Prostate Brachytherapy Advisory Group has launched a new website www.prostatebrachytherapyinfo.net which provides current information on LDR brachytherapy and practical resources to help decision-making.

John Anderson, CEO of the Prostate Research Campaign UK supports the initiatives of The Prostate Brachytherapy Advisory Group and hopes that it will drive more patients to seek appropriate treatment. “Prostate cancer is equivalent in many ways to breast cancer”, says John Anderson, “both are hormone linked, and yet the patient journey that men undertake is very different. Prostate cancer is still perceived as a less important cancer and quality of life issues are not taken into account”

One of the issues with prostate cancer treatments is the risk of incontinence and impotence, particularly for younger men. Continues John “We get hundreds of calls from men who, quite simply, are not being given the information they need to make an informed choice. One of their greatest fears, which can sometimes delay them seeking treatment, is that they may no longer be sexually active after therapy which, of course, is much less of an issue with treatments such as LDR brachytherapy”

One patient who knows the frustrations of obtaining information is Graham Robson, 53, from Aberdeen who was diagnosed with prostate cancer last year. “I was told that surgery was the best option for me, but when I was discovered that radical prostatectomy had a high risk of impotence and incontinence I knew that my life would never be the same again. It was only through a friend that I heard about LDR brachytherapy and by surfing the web I saw that it seemed to have less side effects. I got in contact with Professor Langley who confirmed this was the case and travelled to Guildford for the procedure. Even better, I was playing golf and back at work within a few days rather than recovering for two months after surgery.”

Dr Ian Gibson, MP, Chair of the All Party Parliamentary Group for Cancer Westminster said, “I welcome the plans of the Prostate Brachytherapy Advisory Group to widen access to brachytherapy for men with prostate cancer. This reinforces the practical advice for healthcare commissioners on brachytherapy, published by the Department of Health in November last year”. Continues Dr Gibson, “All cancer patients must have access to the right choice of treatment for their condition and their circumstances”.


The Prostate Brachytherapy Advisory Group is supported by an unrestricted educational grant from Oncura

References
1. www.channel4.com/news/dispatches/health/health_lottery
2. Interventional Procedures Overview of Low Dose Rate Brachytherapy for
Localised Prostate Cancer (NICE Overview 251, January 2005).
3. Department of Health Advice on the Development of Low Dose Rate (Permanent Seed Implant) Brachytherapy Services for Localised Prostate Cancer in England. (Gateway Reference 7385, November 2006).
4. Comptroller and Auditor General. Tackling Cancer: Improving the patient journey. HC 288 2004-2005. 2005. London, National Audit Office.
5. Frank S, Pisters L, Davis J, Lee A, Bassett R, Kuban D. An Assessment of Quality of Life Following Radical Prostatectomy, High Dose External Beam Radiation Therapy and Brachytherapy Iodine Implantation as Monotherapies for Localized Prostate Cancer. The Journal of Urology, Volume 177, Issue 6, Pages 2151-2156.
6. 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. International Journal Radiation Oncology Biology Physics 2007; 67:57 — 64.

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Date Added: 19-06-2007

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