Journal Mobile

AB Law, DB McLaren
Journal Issue: 
Volume 40: Issue 4: 2010




Prostate cancer incidence is rising due to the ageing population and increased public and doctor awareness. The role of screening is still not clear due to the large number of asymptomatic men who would need to be screened and treated  to  prevent  one  death.  Discussion  of  all  treatment  options  should  be undertaken, with the patient having the opportunity to meet a clinical oncologist and  urological  surgeon. Treatment  options  include  active  surveillance,  external beam  radiotherapy,  brachytherapy  and  surgery.  Low-dose  rate  brachytherapy involves  the  permanent  insertion  of  radioactive  seeds  (half-life  60  days)  under ultrasound  guidance.  It  is  a  good  option  for  many  men  as  impotence  and incontinence rates are lower than for surgery and it has reduced hospital costs and  time  off  work  and  high  rates  of  relapse-free  survival  (90–95%  in  low-risk disease). External beam radiotherapy offers a good treatment for men with more locally advanced disease and men who do not want to undergo an anaesthetic. New developments allow higher doses of radiotherapy to be given with reduced relapse rates and reduced toxicity to neighbouring structures such as bowel and bladder.  High-dose rate brachytherapy involves  the  temporary  insertion  of applicators into the prostate so that a high energy source can temporarily be fed into different positions in the prostate, ensuring a high dose to the prostate gland but minimising dose to the bladder and bowel. It can be used as monotherapy or in combination with external beam radiotherapy.