MEDICAL MATTERS:Radioactive seed implants used in GUH, writes MUIRIS HOUSTON
WE HAVE come a long way in treating cancer in this State. I remember reporting on how inequitable cancer treatment was for people living in various regions. Women in the west, for example, received radiotherapy for breast cancer far less than those living in the greater Dublin area. So it is nice to be able to tell you about the lead being taken by doctors in Galway in providing the most up-to-date treatment for prostate cancer.
Galway University Hospital (GUH) is the only public hospital in Ireland performing prostate (seed implant) brachytherapy. This is a technique to treat prostate cancer by strategically placing radioactive seeds inside the prostate gland where they remain to irradiate the malignant tissue within the prostate.
The first prostate brachytherapy case was carried out in GUH in September 2007. To date, almost 350 procedures have been performed at the hospital, with about one-third of the patients travelling there from other regions in the State.
According to Prof Frank Sullivan, lead clinician at the department of radiation oncology in GUH, the hospital will perform 100-120 procedures this year.
Brachytherapy is just one of the treatment options available to men diagnosed with prostate cancer: the others are external beam radiation – the “traditional” form of radiotherapy which is applied from outside the body – and surgery to remove the tumour.
Sometimes the decision as to which option is best can be a tricky one.
Recently, one of the world’s leading prostate cancer specialists came to Galway to talk about comparing treatment results of prostate malignancy. Dr Peter Grimm of the Prostate Cancer Centre of Seattle said key questions for patients are “Will I be cured?” or “Will my treatment make me cancer free?”
The best measurement tool, a blood test called the prostate specific antigen (PSA) cannot, however, answer these questions absolutely.
“We can only indicate that the treatment was successful if PSA numbers do not indicate cancer progression,” he said.
Which is where things can get a little tricky. If you have your prostate removed surgically, then PSA readings usually fall rapidly to very low numbers and stay low.
However, after radiation treatment for prostate cancer, PSA numbers usually come down more slowly; they might increase and then fall in the first one to three years (a “PSA bump”) and then level out, but at a higher number than that seen in patients following surgery. In other words, the numbers game gets complicated by whatever form of treatment you choose.
Grimm also discussed the results of a large study he and others completed last year. This showed that for most patients in the low-risk category – those whose cancer is caught early and is localised within the gland – most therapies will be successful.
However, the success rate for most groups is greater for brachytherapy compared with both external beam radiation and surgery. “Patients should be encouraged to look at the graphs and determine for themselves,” he said.
A major consideration for men with newly diagnosed prostate cancer is the issue of side effects from treatment.
Urinary incontinence and erectile dysfunction are risks with surgery, while urinary irritation is a recognised side effect after brachytherapy.
Ask your specialist about this and, if you are initially seeing a urologist, ask if you can have the opinion of a radiation oncologist before you finally choose a treatment option.
“Data from the National Cancer Registry show that Ireland has the highest incidence of prostate cancer in Europe and the west of Ireland has the highest rates in Ireland,” Sullivan said.
“This means that we are ideally placed in Galway to provide treatment for prostate cancer. In 2009, GUH was one of two pilot sites for the new rapid access prostate diagnostic clinics along with St James’s in Dublin.”
The good news is that St Luke’s Hospital in Dublin and Cork University Hospital hope to carry out the first radioactive seed implants for prostate cancer later this year.