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Identifying good candidates for prostate cancer brachytherapy: New testing helps doctors determine those best suited for treatment

Simple and inexpensive pretreatment testing can help identify patients who are vulnerable to urinary complications from brachytherapy treatment for prostate cancer.

Over a three-year period, doctors at Mayo Clinic in Jacksonville studied the medical records of 105 men who received radioactive seed implants with or without external beam radiotherapy or hormone blockade.

Although most patients undergoing radioactive seed implants for prostate cancer do well, a few can have problems, including urinary retention, urinary frequency, pain on urination or needing catheterization to urinate.

Of the men studied, 56 percent were classified as high-risk and 44 percent at low-risk for developing urinary tract difficulties after treatment. Researchers assessed conditions such as severity of symptoms, urinary flow rate, residual urinary volume and prostate volume.

In the end, 37 percent of the high-risk patients developed some urinary difficulties after the therapy, and 85 percent of the low-risk patients did not. Using these assessments, physicians can better select patients and offer them educational counseling to avoid serious complications after brachytherapy.

"The results offer physicians some simple and inexpensive pretreatment testing that helps identify patients who would be at increased risk for developing urinary complications," says Dr. Michael Wehle, a Mayo Clinic urologist who co-authored the study with colleague Dr. Scott Lisson.

Brachytherapy involves placing radioactive seeds in or near the tumor to deliver a high dose of radiation to the cancer while reducing the radiation exposure in surrounding healthy tissue. This may be done surgically or through other means, such as using a needle.

"Radical prostatectomy, brachytherapy and external beam radiation therapy are very effective treatments for early stage prostate cancer," says radiation oncologist Dr. Steven Buskirk.

Doctors agree that these findings will allow them to better select patients and offer them educational counseling to avoid serious complications after brachytherapy. Once these tools are established, patients can be directed toward therapies that are least likely to negatively affect their quality of life.

"The optimal treatment for each patient should be individualized," says Buskirk.

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