Focal brachytherapy: personalised care for prostate cancer

Focal brachytherapy: personalised care for prostate cancer

13 November, 2020

Prostate cancer is the most common cancer diagnosed in Victorian men, accounting for around a third (27%) of cases, with the number of new cases increasing each year.1

For many men, prostate cancer treatment involves significant side effects including urinary incontinence and sexual dysfunction. Advances in radiation therapy have reduced significant side effects in treating prostate cancer, making it an excellent consideration for first-line treatment.

In an Australian first, Icon Cancer Centre are proud to launch the LIBERATE clinical registry in partnership with Epworth Healthcare, which aims to support the use of new precision focal brachytherapy for men with prostate cancer and reduce side effects to preserve their quality of life. The latest in prostate cancer diagnosis and treatment

Patients now have access to several advanced imaging technologies which are used by urologists to diagnose prostate cancer with greater accuracy, including multi-parametric MRI and PSMA PET scanning alongside the introduction of targeted trans-perineal prostate biopsy.

These advanced diagnostics have also facilitated an unprecedented understanding of the specific location(s) of the cancer within the gland itself, which allows doctors to ‘focally’ treat just the diseased region rather than removing or ablating the entire organ. The benefit of this approach is the potential to further reduce treatment-related side effects, enhance survivorship with equivalent rates of cancer cure.

There are many other examples in cancer treatment where similar organ preservation strategies have revolutionised patient care, such as with the management of breast cancer, whereby a lumpectomy is now routinely performed unlike many years ago when the only option available for women was a mastectomy.

What is focal brachytherapy?

Focal low dose rate brachytherapy (also known as focal seed brachytherapy) involves the implantation of small radioactive seeds, usually around 14-30, via the trans-perineal route directly into the cancerous area of the prostate. These seeds are radioactive for three months to deliver radiation to destroy the cancer over a short period of time. Unlike traditional brachytherapy, the seeds are placed into the tumour rather than the whole prostate, preserving the rest of the prostate gland and limiting side effects.

Focal brachytherapy is a minimally invasive procedure which requires a single day surgery. The advanced treatment helps men quickly return to normal life without additional side effects, while actively fighting the cancerous cells for up to three months after the surgical treatment.

Whole gland seed brachytherapy has been available for over 40 years and is supported by a considerable body of evidence attesting to its long-term safety and efficacy. Seed brachytherapy is therefore an attractive candidate for focal therapy.

Australian-first clinical registry LIBERATE is a prospective registry study that is recruiting men with clinically localised low to intermediate risk prostate cancer. To be eligible, the diagnostic work-up must show that the tumour is confined to only one small area of the prostate and hence easily targetable with a small brachytherapy implant.

Close follow-up of patients will be overseen to determine both the effects of treatment on long term quality of life and rates of cancer control, the latter of which will be determined with regular PSA blood tests and a second MRI scan and biopsy of the prostate scheduled for 18 months after surgery. The registry will span across a five-year period to determine the effects of treatment on long term quality of life and rates of cancer control.

Dr Andrew See is a radiation oncologist at Icon Cancer Centre Richmond and Icon Cancer Centre Freemasons, and A/Prof Jeremy Grummet is a urologic surgeon at Epworth HealthCare.

For more information or to refer a patient, please contact:

Dr Andrew See, Principal Investigator, Icon Cancer Centre Richmond, Epworth Healthcare

P 03 9936 8277 | F 03 9936 8269 |E

A/Prof Jeremy Grummet, Co-Principal Investigator, Urologic Surgeon, Epworth Healthcare

P 03 8506 3646 | F 03 8506 3699 |E