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Guidelines confirm: Less impotence and incontinence after seed implantation than after surgery
Cologne February 24, 2010 - What has already been proven by numerous international studies has now been confirmed by leading experts: Prostate cancer patients who receive brachytherapy (internal radiation) suffer significantly less frequently from impairment of their potency and urinary incontinence after treatment.
"The cancer has to come out, and as quickly as possible." That was the first thing that came to Joachim P. from Bergisch Gladbach's mind when his urologist told him the news that his prostate was affected by a malignant tumor. After that, everything happened incredibly quickly, recalls the 62-year-old architect. Just one week later, the prostate was completely removed in a two-hour operation, followed by a stay of several weeks in a rehabilitation clinic. Despite intensive pelvic floor training, Joachim P. is still unable to hold his urine optimally two years after the operation. In addition, his erectile function is severely impaired.
Joachim P. is not an isolated case. Every year, around 58,000 men are diagnosed with prostate cancer. Of these, the majority of men in Germany have their prostate radically removed by surgery. "Often, the surgery date is already set without the patient having had a chance to find out about alternative and gentler treatment options," reports Dr. Pedram Derakhshani. "Side effects such as incontinence and impotence are unreservedly accepted by many of those affected," says the urologist from the West German Prostate Center in Cologne. Yet despite nerve-sparing surgical techniques, the numbers are still very high, as recently published in the new guidelines for early detection, diagnosis and treatment of prostate cancer (1): According to these, at most one in two patients suffers from stress incontinence after surgery and 30 to 100 percent from erectile dysfunction. (1/2)
Seed implantation much gentler
According to Derakhshani, the fact that radical removal of the prostate gland is nevertheless considered by many physicians in Germany to be the only successful treatment option for prostate cancer is long outdated. Numerous studies4 show that surgery, brachytherapy (internal radiation) and external radiation achieve the same cure rates in patients whose tumor is confined to the prostate.
Brachytherapy has a significant advantage over surgery: "By precisely distributing the radiation dose, we can irradiate the tumor without damaging surrounding structures such as the urethra or sphincter ," explains Dr. Gregor Spira, radiation therapist at WPZ. For example, several studies, including a U.S. study from August of this year, show that erectile dysfunction occurs in 70 percent after radical surgery and in 14 percent after seed implantation4. Urinary incontinence, which is as high as 50 percent after radical removal of the prostate, is also negligible at 0.3 to 3 percent after seed implantation and really only occurs after prior prostatectomy(TURP).
In addition, brachytherapy is also superior to surgery in terms of quality of life and patient satisfaction. This is shown by results of the largest patient survey nationwide5: 93 percent of patients who opted for brachytherapy were very satisfied with the choice of treatment. In contrast, satisfaction after radical surgery was only 79 percent.