Slide 1 Hello my name is Mark Buyyounouski.
I am a Radiation Oncologist at Stanford Cancer Center and I specialize in the treatment of
prostate cancer.
In this video, I will be discussing prostate brachytherapy particularly as a boost to external
beam treatment for the treatment of prostate cancer.
Slide 2 Shown here is the web address to a full length
video discussing the treatment of prostate cancer which includes a discussion of risk
assessment, comprehensive discussion of external beam radiotherapy, image guided radiotherapy,
brachytherapy, as well as the follow up of prostate cancer and the value of formal therapy.
Slide 3 There are two primary forms of treatment at
Stanford, radiotherapy approach shown on the left where the patient lays flat on the table
while a machine like an x-ray machine rotates around the patient focusing radiation at the
prostate.
The other technique used to treat prostate cancer is brachytherapy.
At Stanford we use a temporary high dose brachytherapy technique which is shown on the right.
The inset color pictures are topography maps of the radiation dose that is delivered from
either technique.
From the external beam technique or VMAT volumetric modulate arc therapy you can see there is
a greater dose to the rest of the body as the radiation penetrates from the outside
in.
On the right you can see with brachytherapy or HDR the body receives a lower dose of radiation
therapy while there is a high concentration of radiation centered on the prostate.
Increasingly, were learning that combining these two treatments is more effective in
reducing the risk of prostate cancer than using external beam treatment alone.
Slide 4 In an historical experience from new Peter
MacCallum Cancer Center in Australia, investigator there have found in approximately 10 per cent
improvement in reducing the occurrence of prostate cancer at 5 years when adding HDR
to 5 weeks of external beam radio therapy compared to external beam radio therapy alone.
Similarly, Canadian investigators have found a similar benefit at 5 years in reducing the
risk of prostate cancer occurrence when combining external beam radio therapy with HDR brachytherapy
versus external beam radio therapy alone.
Slide 5 The group at Memorial Sloan Kettering Cancer
Center in New York has also found combining HDR brachytherapy is better than using external
beam radiotherapy alone for both intermediate and high risk patients.
Slide 6 Most recently results from a randomized phase
III clinical trial had demonstrated that combination therapy, external beam with brachytherapy
reduces the risk of PSA recurrence compared to external beam treatment alone with patients
with intermediate or high risk prostate cancer.
What’s important to note is that 5 years a similar approximate 10 percent benefit in
the reduction of prostate cancer recurrence was found.
Although this study used a lose dose rate permanent brachytherapy technique, the concept
is the same that intensifying the dose over to the prostate with an internal brachytherapy
technique is beneficial to an external beam technique alone.
When the results from Australia, Canada, Memorial Sloan Cancer Center and the ascend randomized
trial results are taken together all experience indicate that combination therapy with external
beam and internal radiation with brachytherapy reduces the risk of prostate cancer recurrence
as measured by a detectable in rise in PSA by approximate ten per cent at 5 years .
Slide 7 It’s also important to note that this is
true even of high risk patients as shown here and patients with high grade disease with
a Gleason score of 9 or 10 as shown in this experiment from the University of Michigan.
In this review adding internal brachytherapy not only reduces the occurrence of PSA, but
reduced the spreading of prostate cancer and death from prostate cancer.
Slide 8 I hope you found this video helpful.
I wish you good luck with your decision making.
For further information regarding Prostate Brachytherapy you can visit www.americanbrachytherapysocity.org
or schedule an appointment to see me in consultation at Stanford at the information shown here.
Thank you.