SHOULD BRACHYTHERAPY BE CONSIDERED A THERAPEUTIC OPTION IN LOCALIZED PROSTATE CANCER? - 11/09/11
Résumé |
The development of prostate-specific antigen (PSA) and transrectal ultrasonography (TRUS) in the 1980s has led to both a surge in the absolute incidence of prostate carcinoma and to an increase in the proportion of early-stage disease diagnosed. Between 1986 and 1990 the incidence of prostate cancer in American men rose an average of 8.2% annually.26 In contrast, between 1975 and 1979 the age-adjusted incidence rate increased a mere 2.2% per annum.26 According to surveys by the American College of Surgeons Commission on Cancer, 43% of patients diagnosed in 1975 had advanced-stage disease; by 1990, this percentage had dropped to 33%.50
The ultimate clinical significance of early-stage disease detected by PSA is currently a source of active debate with scientific, political, and economic overtones. Some authorities advocate an expectant management strategy for low-grade and stage tumors.21, 37, 76 Critics of aggressive treatment cite quality-of-life studies that demonstrate significant morbidity associated with radical prostatectomy or external beam irradiation.21, 47, 76 From these studies, it is questioned whether the treatment sequelae are justified by the uncertain survival benefit of definitive therapy for earlystage disease, particularly in older men.21
From this setting has emerged a renewed interest in relatively low-risk, curative therapies for carcinoma of the prostate. Brachytherapy, once abandoned as a treatment option, has again been posited as an alternative to prostatectomy or external beam irradiation.5, 58 The rekindling of interest in brachytherapy has resulted not only from a demand for a more cost-effective, lower-morbidity treatment, but also from advancements in imaging technology, treatment planning software, and delivery apparatus that have culminated in a technique that appears exacting and reproducible. This article explores the technical underpinnings of contemporary brachytherapy and examines the current published data relating to the effectiveness and morbidity of this modality.
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| Address reprint requests to John C. Blasko, MD, Northwest Tumor Institute, G-16, 1560 North 115th Street, Seattle, WA 98133 |
Vol 23 - N° 4
P. 633-650 - novembre 1996 Retour au numéro
Article précédent
- SHOULD CRYOSURGERY BE CONSIDERED A THERAPEUTIC OPTION IN LOCALIZED PROSTATE CANCER?
- John A. Connolly, Katsuto Shinohara, Joseph C. Presti, Peter R. Carroll
- INCIDENCE AND SIGNIFICANCE OF POSITIVE MARGINS IN RADICAL PROSTATECTOMY SPECIMENS
- Jonathan I. Epstein
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