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Brachytherapy: The precise answer for tackling prostate cancer Prostate key messages.

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Presentation on theme: "Brachytherapy: The precise answer for tackling prostate cancer Prostate key messages."— Presentation transcript:

1 Brachytherapy: The precise answer for tackling prostate cancer Prostate key messages

2 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Core key messages, in a nutshell The precise answer for tackling prostate cancer Maximal conformity – precise targeting of effective dose to tumor with sparing of healthy tissues and organs (working from the inside, out) Customized delivery of radiation dose, tailored to the precise needs to treat the tumor Demonstrated efficacy – equivalent to EBRT and prostatectomy (surgery) Well tolerated – minimizes side effects compared to EBRT and prostatectomy Patient centered – shorter treatment and recovery times, minimizes disruption and impact on QOL Optimizes healthcare resources Solid heritage – extensive clinical experience, backed by technological advances, confirm brachytherapy as a standard of care in prostate cancer management

3 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE The intro: Brachytherapy is a cornerstone in prostate cancer management The incidence of prostate cancer is rising and will continue to increase as the population ages. Cancer of the prostate is the most commonly diagnosed malignancy in Western men Effective treatment options mean many men can achieve good cancer control and quality of life. Innovation in cancer treatment is key to addressing current and future needs in patient care. Tumor control and survival rates for prostate cancer achieved with brachytherapy, EBRT and surgery are excellent, and comparable across the different modalities. Other factors, such as treatment duration, side effects, impact on quality of life and patient preference are therefore important considerations when making treatment choices. Innovations in brachytherapy continue to enhance treatment options, allowing for care to become patient-centered; tailored by individual preferences and needs

4 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: The key messages Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target, minimizing healthy tissue damage and so reducing side effects. HDR brachytherapy provides superior conformity compared to other modern techniques, such as IMRT and tomotherapy LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high- risk) demonstrate excellent long term cancer control rates which equals that of RP and EBRT LDR seed therapy allows a high dose of radiation to be delivered precisely while sparing surrounding healthy tissue, minimizing the bowel, bladder and sexual function side effects which would otherwise impact quality of life In HDR brachytherapy, precision placement of the source and sequential fractionation also mean less damage to surrounding healthy tissue and organs, and thus minimized toxicity and side effects, such as bowel and bladder problems Prostate brachytherapy allows for significantly shorter treatment times, often on an out- patient basis, compared to EBRT – day(s) compared to weeks; and shorter recovery times compared to radical prostatectomy, with minimized impact on functional outcomes and quality of life Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) provide a key solution in optimizing healthcare resources, delivering clinical efficacy and patient-centered therapy on a cost-effective basis Prostate cancer has been treated with LDR seed brachytherapy since the 1960s. It has become a standard of care in many countries through its disease specific survival and unrivalled patient benefits. Recent technological advances have augmented the quality of treatment which can be achieved with LDR and HDR techniques ConformityConformity EfficacyEfficacy Well tolerated Patient centered Optimizes resources HeritageHeritage

5 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Maximal conformity – precise targeting Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target, minimizing healthy tissue damage and so reducing side effects. HDR brachytherapy provides superior conformity compared to other modern radiotherapy techniques, such as IMRT and tomotherapy Tailored treatment The number and position of seeds (LDR), or the position and duration of the dwell time of the radioactive source (HDR), used to deliver the radiation dose in prostate brachytherapy can be tailored specifically to the patients individual needs – maximizing outcomes and at the same time limiting surrounding tissue or organ damage. Modern techniques Modern prostate brachytherapy takes advantage of advances in ultrasound imaging, hardware technology and software development to provide implants under real-time ultrasound guidance coupled with a dynamic assessment of the implant, which thus optimizes the precision of dose delivery to the target area. HDR brachytherapy demonstrates superior conformity to techniques such as IMRT and tomotherapy, with sparing of healthy tissues and reduced radiation exposure Minimally invasive Compared to radical prostatectomy, the minimally invasive nature of prostate brachytherapy significantly reduces the risk of side effects such as sexual dysfunction and long term urinary problems, as well as allowing shorter recovery times. Quality control Prostate brachytherapy is the ultimate in terms of quality control of treatment delivery – dosimetry and insertion can be done under real-time conditions ensuring that the desired dose is delivered exactly where it is needed, maximizing treatment outcomes (closed loop treatment).

6 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high-risk) demonstrate excellent long term cancer control rates which match those of RP and EBRT Prostate brachytherapy: Demonstrated efficacy Equivalent cancer control rates and outcomes LDR seed therapy demonstrates excellent 5-, 10- and even 15-year treatment outcomes, matching those reported in studies of radical prostatectomy (RP) and external beam radiation therapy (EBRT). Data on HDR in combination with EBRT demonstrate excellent 5- and 10-year outcomes, and increasing data on HDR monotherapy demonstrate similar excellent prostate cancer treatment outcomes. Superior efficacy In a matched-pair analysis of low- to intermediate-risk patients with localized prostate cancer, permanent seed implants were shown to produce significantly better prostate cancer control rates at 5 years than traditional EBRT. Flexible synergistic treatment Both permanent (LDR seed therapy) and temporary (HDR) implants have shown to work synergistically (as a boost) with EBRT and with androgen deprivation therapy (ADT) in higher risk patients.

7 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE LDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue, minimizing the bowel, bladder and sexual function side effects which would otherwise impact quality of life In HDR brachytherapy, precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs, and thus less toxicity and side effects, such as bowel and bladder problems Prostate brachytherapy: Well tolerated with minimized side effects Minimizes dose to surrounding tissue/spares surrounding organs Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) ensures radiation is precisely targeted to the area of the tumor, eliminating unnecessary exposure and damage to surrounding healthy tissues and organs. Use of HDR as a boost after EBRT allows dose escalation to target areas, whilst minimizing exposure to healthy tissues and organs. Minimizes toxicity and side effects Patients receiving prostate brachytherapy (LDR seed therapy and HDR brachytherapy) suffer significantly decreased side effects such as bowel function and bother, and sexual dysfunction. In addition, prostate brachytherapy demonstrates better urinary incontinence rates, compared to RP and EBRT. Urinary function Urinary function is affected by all radiotherapy and surgical procedures in localized prostate cancer. Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) may result in transient urinary function issues that generally resolve rapidly – consistent with the working of the radiation, with lower longer-term urinary issues compared to RP.

8 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy allows for significantly shorter treatment times, often on an out-patient basis, compared to EBRT – day(s) compared to weeks, and shorter recovery times compared to radical prostatectomy, with minimal impact on functional outcomes and quality of life Prostate brachytherapy: Patient-centered with minimized impact on QoL Minimally invasive, shorter recovery time Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) avoids the physical and emotional trauma, potential blood loss and longer hospitalization associated with a major surgical procedure such as RP. Recovery from prostate brachytherapy (LDR seed therapy and HDR brachytherapy) is significantly quicker (2–3 days) compared to RP (4–6 weeks) which means patients lives are not put on hold. Shorter treatment duration – reduced disruption to daily life Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) placement is direct to the tumor site so the treatment can be completed in a day or days on an outpatient basis, compared to a period of weeks with EBRT. Lower personal and hospital costs Prostate brachytherapy (LDR seed therapy and HDR brachytherapy ) is a short outpatient procedure, completed in 1-2 days. This makes it less intrusive on daily life and lowers personal (and hospital) costs associated with the multiple treatments sessions of EBRT and lengthy RP recovery time. Minimal disruption to patients quality of life Studies using specific QoL scales demonstrate that brachytherapy is generally associated with minimal impact on HRQoL with respect to urinary, sexual and bowel function, and with a favorable HRQoL profile compared to EBRT and RP, and even newer techniques such as Da Vinci and cryotherapy.

9 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy (LDR seed therapy and HDR brachytherapy) provides a key solution in optimizing healthcare resources, delivering clinical efficacy and patient-centered therapy on a cost- effective basis Cost effectiveness vs. frequently used alternative modalities Prostate brachytherapy: Optimized healthcare resources Like IMRT and proton therapy, brachytherapy delivers high dose to tumor targets, while limiting damage to healthy tissues, but brachytherapy only needs low investment and maintenance costs, making brachytherapy more attractive for cost-effectiveness considerations and for healthcare resource investment decisions. Modern radiotherapy, with low investment costs Brachytherapy has been shown to be a cost-effective alternative to surgery, EBRT and newer technologies such as IMRT or proton therapy. A recent review by the ICER group in the USA confirmed brachytherapy as a high value treatment modality compared to approaches such as IMRT and protons. Use of brachytherapy for appropriate patients allows a department to free up time for Linac use, reducing congestion, maximizing patient flow and optimizing department resources. Brachytherapy offers opportunity to maximize radiotherapy department resources

10 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s. It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits Prostate brachytherapy: Solid heritage Heritage LDR seed therapy has been used for almost 50 years for the treatment of localized prostate cancer. Global acceptance The major urological societies recognize the importance of LDR seed therapy in their guidelines for the management of localized prostate cancer. Evidence based Since the 1960s there have been over 2,500 publications on the use of brachytherapy in the management of localized prostate cancer. Continued advances Transrectal ultrasonography (TRUS) guidance, template guided closed transperineal technique and sophisticated planning software have enabled prostate brachytherapy (LDR seed therapy and HDR brachytherapy) to evolve into a state-of-the-art procedure. Constant technique development means better patient QoL Ongoing improvement in technology has developed to include temporary HDR brachytherapy for treating prostate cancer. This offers all benefits of LDR seed therapy, such as short course (2 days) and precision targeting, but with an even more preferable toxicity profile leading to greater quality of life for patients.

11 Key message citations

12 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Maximal conformity – precise targeting Precision source placement with both LDR (seed brachytherapy) and HDR enables treatment directly to the target site, minimizing healthy tissue damage and so reducing side effects. HDR brachytherapy provides superior conformity compared to other modern techniques, such as IMRT and tomotherapy 1.Holloway C, Hsu I. Albert C et al. Prostate brachytherapy. In Devlin, Brachytherapy: Applications and techniques. Philadelphia, PA. LWW Holloway C, Hsu I. Albert C et al. Prostate brachytherapy. In Devlin, Brachytherapy: Applications and techniques. Philadelphia, PA. LWW Frank S, Pisters L, Davis J et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. Jnl Urol 2007;177: Frank S, Pisters L, Davis J et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. Jnl Urol 2007;177: Phan T, Syed A, Puthawala A et al. High dose rate brachytherapy as a boost for the treatment of localized prostate cancer. Jnl Urol 2006;177: Phan T, Syed A, Puthawala A et al. High dose rate brachytherapy as a boost for the treatment of localized prostate cancer. Jnl Urol 2006;177: Pötter R. Image-guided brachytherapy sets benchmarks in advanced radiotherapy. Radiother Oncol 2009;91(2):141-6.Pötter R. Image-guided brachytherapy sets benchmarks in advanced radiotherapy. Radiother Oncol 2009;91(2): Back to key messages

13 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Maximal conformity – precise targeting (contd) Tailored treatment: 1.Holloway C, Hsu I. Albert C et al. Prostate brachytherapy. In Devlin, Brachytherapy: Applications and techniques. Philadelphia, PA. LWW Holloway C, Hsu I. Albert C et al. Prostate brachytherapy. In Devlin, Brachytherapy: Applications and techniques. Philadelphia, PA. LWW Koukourakis G, Kelekis N, Armonis V et al. Brachytherapy for prostate cancer. Adv Urol 2009: Article ID Koukourakis G, Kelekis N, Armonis V et al. Brachytherapy for prostate cancer. Adv Urol 2009: Article ID Nobes J, Khaskar S, Hawkins M et al. Novel prostate brachytherapy technique: Improved dosimetric and clinical outcome. Radiother Oncol 2008;88: Nobes J, Khaskar S, Hawkins M et al. Novel prostate brachytherapy technique: Improved dosimetric and clinical outcome. Radiother Oncol 2008;88: Back to key messages

14 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Maximal conformity – precise targeting (contd) Modern techniques: 1.Holloway C, Hsu I. Albert C et al. Prostate brachytherapy. In Devlin, Brachytherapy: Applications and techniques. Philadelphia, PA. LWW Holloway C, Hsu I. Albert C et al. Prostate brachytherapy. In Devlin, Brachytherapy: Applications and techniques. Philadelphia, PA. LWW Frank S, Pisters L, Davis J et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. Jnl Urol 2007;177: Frank S, Pisters L, Davis J et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. Jnl Urol 2007;177: Zelefsky M, Yamada Y, Cohen G et al. Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 2007;67(1)65-70.Zelefsky M, Yamada Y, Cohen G et al. Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 2007;67(1) Hoskin P and Bownes P. Innovative technologies in radiation therapy: Brachytherapy. Semin Radiat Oncol 2006;16: Hoskin P and Bownes P. Innovative technologies in radiation therapy: Brachytherapy. Semin Radiat Oncol 2006;16: Fatyga M, Williamson JF, Dogan N, et al. A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer: a radiobiological modeling study. Med Phys 2009;36(9): Fatyga M, Williamson JF, Dogan N, et al. A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer: a radiobiological modeling study. Med Phys 2009;36(9): Hermesse J, Biver S, Jansen N, et al. A dosimetric selectivity intercomparison of HDR brachytherapy, IMRT and helical tomotherapy in prostate cancer radiotherapy. Strahlenther Onkol. 2009;185:736-42Hermesse J, Biver S, Jansen N, et al. A dosimetric selectivity intercomparison of HDR brachytherapy, IMRT and helical tomotherapy in prostate cancer radiotherapy. Strahlenther Onkol.2009;185: Back to key messages

15 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Maximal conformity – precise targeting (contd) Minimally invasive: 1.Stone N and Stock R. Long-term urinary, sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years. Urol 2007;69; Stone N and Stock R. Long-term urinary, sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years. Urol 2007;69; Hoskin P and Bownes P. Innovative technologies in radiation therapy: Brachytherapy. Semin Radiat Oncol 2006;16: Hoskin P and Bownes P. Innovative technologies in radiation therapy: Brachytherapy. Semin Radiat Oncol 2006;16: Ferrer M, Suareze J, Guedea et al. Health-related quality of life 2 years after treatment with radical prostatectomy, prostate brachytherapy, or external beam radiotherapy in patients with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 2008;72(2): Ferrer M, Suareze J, Guedea et al. Health-related quality of life 2 years after treatment with radical prostatectomy, prostate brachytherapy, or external beam radiotherapy in patients with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 2008;72(2): Prostate Cancer Charity. Available at: Accessed 30/10/09. Back to key messages

16 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Maximal conformity – precise targeting (contd) Quality control: 1.Grimm P and Sylvester J. Advances in brachytherapy. Rev Urol 2004;6 (Suppl 4):S37-S48.Grimm P and Sylvester J. Advances in brachytherapy. Rev Urol 2004;6 (Suppl 4):S37-S48. 2.Koukourakis G, Kelekis N, Armonis V et al. Brachytherapy for prostate cancer. Adv Urol 2009: Article ID Koukourakis G, Kelekis N, Armonis V et al. Brachytherapy for prostate cancer. Adv Urol 2009: Article ID Back to key messages

17 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Demonstrated efficacy LDR seed therapy (low- to intermediate-risk) and HDR brachytherapy (intermediate- to high- risk) demonstrate excellent long term cancer control rates which matches that of RP and EBRT 1.Pickles T, Keyes M, Morris W et al. Brachytherapy or conformal external radiotherapy for prostate cancer: A single institution matched-pair analysis. Int J Radiat Oncol Biol Phys 2010;76(1):43-49.Pickles T, Keyes M, Morris W et al. Brachytherapy or conformal external radiotherapy for prostate cancer: A single institution matched-pair analysis. Int J Radiat Oncol Biol Phys 2010;76(1): Moule R and Hoskin P. Non-surgical treatment of localized prostate cancer. Surg Oncol 2009;18; Moule R and Hoskin P. Non-surgical treatment of localized prostate cancer. Surg Oncol 2009;18; Batterman J, Boon T and Moerland A. Results of permanent prostate brachytherapy, 13 years of experience at a single institution. Radiother Oncol 2004;71:23-28.Batterman J, Boon T and Moerland A. Results of permanent prostate brachytherapy, 13 years of experience at a single institution. Radiother Oncol 2004;71: Henry AM, Al-Qaisieh B, Gould K, et al. Outcomes following iodine-125 monotherapy for localized prostate cancer: the results of Leeds 10-year single-center brachytherapy experience. Int J Radiat Oncol Biol Phys 2010;76(1):50-56.Henry AM, Al-Qaisieh B, Gould K, et al. Outcomes following iodine-125 monotherapy for localized prostate cancer: the results of Leeds 10-year single-center brachytherapy experience. Int J Radiat Oncol Biol Phys 2010;76(1): Hinnen KA et al. Loose seeds versus stranded seeds in I-125 prostate brachytherapy: Differences in clinical outcome. Radiother Oncol, 2010 (E Pub ahead of press)Hinnen KA et al. Loose seeds versus stranded seeds in I-125 prostate brachytherapy: Differences in clinical outcome. Radiother Oncol, 2010 (E Pub ahead of press) 6.Koukourakis G, Kelekis N, Armonis V, Kouloulias V. Brachytherapy for prostate cancer: a systematic review. Adv Urol 2009:327945Koukourakis G, Kelekis N, Armonis V, Kouloulias V. Brachytherapy for prostate cancer: a systematic review. Adv Urol 2009: Pisansky TM, Gold DG, Furutani KM, et al. High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer. Mayo Clin Proc 2008;83(12): Pisansky TM, Gold DG, Furutani KM, et al. High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer. Mayo Clin Proc 2008;83(12): Back to key messages

18 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Demonstrated efficacy (contd) Equivalent outcomes: 1.Pickles T, Keyes M, Morris W et al. Brachytherapy or conformal external radiotherapy for prostate cancer: A single institution matched-pair analysis. Int J Radiat Oncol Biol Phys 2010;76(1):43-49.Pickles T, Keyes M, Morris W et al. Brachytherapy or conformal external radiotherapy for prostate cancer: A single institution matched-pair analysis. Int J Radiat Oncol Biol Phys 2010;76(1): Moule R and Hoskin P. Non-surgical treatment of localized prostate cancer. Surg Oncol 2009;18; Moule R and Hoskin P. Non-surgical treatment of localized prostate cancer. Surg Oncol 2009;18; Batterman J, Boon T and Moerland A. Results of permanent prostate brachytherapy, 13 years of experience at a single institution. Radiother Oncol 2004;71:23-28.Batterman J, Boon T and Moerland A. Results of permanent prostate brachytherapy, 13 years of experience at a single institution. Radiother Oncol 2004;71: Sylvester J, Grimm P, Wong J et al. Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients. Brachyther 2009;8: Abstr. PO101.Sylvester J, Grimm P, Wong J et al. Prostate brachytherapy biochemical relapse-free survival outcomes in intermediate-risk prostate cancer patients. Brachyther 2009;8: Abstr. PO Stone N and Stock R. Long-term urinary, sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years. Urol 2007;69; Stone N and Stock R. Long-term urinary, sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years. Urol 2007;69; Sylvester J, Grimm P, Blasko J et al. 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy; Seattle experience. Int J Radiat oncol Biol Phys 2007;67(1):57-64.Sylvester J, Grimm P, Blasko J et al. 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy; Seattle experience. Int J Radiat oncol Biol Phys 2007;67(1): Ragde H, Blasko J and Grimm P et al. Brachytherapy for clinically localized prostate cancer: Results at 7- and 8-year follow up. Semin Surg Oncol 1997;13: Ragde H, Blasko J and Grimm P et al. Brachytherapy for clinically localized prostate cancer: Results at 7- and 8-year follow up. Semin Surg Oncol 1997;13: Institute for Clinical and Economic Review. Management Options for Low-Risk Prostate Cancer: A Report on Comparative Effectiveness and Value. 2010Institute for Clinical and Economic Review. Management Options for Low-Risk Prostate Cancer: A Report on Comparative Effectiveness and Value Back to key messages

19 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Demonstrated efficacy (contd) Superior efficacy: 1.Pickles T, Keyes M, Morris W et al. Brachytherapy or conformal external radiotherapy for prostate cancer: A single institution matched-pair analysis. Int J Radiat Oncol Biol Phys 2010;76(1):43-49.Pickles T, Keyes M, Morris W et al. Brachytherapy or conformal external radiotherapy for prostate cancer: A single institution matched-pair analysis. Int J Radiat Oncol Biol Phys 2010;76(1): Flexible synergistic treatment: 1.Sylvester J, Grimm P, Blasko J et al. 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy; Seattle experience. Int J Radiat oncol Biol Phys 2007;67(1):57-64.Sylvester J, Grimm P, Blasko J et al. 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy; Seattle experience. Int J Radiat oncol Biol Phys 2007;67(1): Merrick G, Butler W, Wallner K et al. Impact of supplemental external beam radiotherapy and/or androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2005;61(1);32-43.Merrick G, Butler W, Wallner K et al. Impact of supplemental external beam radiotherapy and/or androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2005;61(1); Kovács G, Pötter R, Lock T et al. GEC/ESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer. Radiother Oncol 2005;74: Kovács G, Pötter R, Lock T et al. GEC/ESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localized prostate cancer. Radiother Oncol 2005;74: Phan T, Syed A, Puthawala A et al. High dose rate brachytherapy as a boost for the treatment of localized prostate cancer. Jnl Urol 2006;177: Phan T, Syed A, Puthawala A et al. High dose rate brachytherapy as a boost for the treatment of localized prostate cancer. Jnl Urol 2006;177: Hoskin PJ, Motohashi K, Bownes P, et al. High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer: initial results of a randomised phase three trial. Int J Radiother Oncol 2007;84(2): Hoskin PJ, Motohashi K, Bownes P, et al. High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer: initial results of a randomised phase three trial. Int J Radiother Oncol 2007;84(2): Back to key messages

20 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Well tolerated with minimized side effects LDR seed therapy allows a high dose of radiation to be delivered precisely to the target area while sparing surrounding healthy tissue, minimizing the bowel, bladder and sexual function side effects which would otherwise impact quality of life In HDR brachytherapy, precision placement of the source into the target treatment area and sequential fractionation also mean less damage to surrounding healthy tissue and organs, and thus less toxicity and side effects, such as bowel and bladder problems 1.Prostate Brachytherapy Advisory Group. Available at: Accessed 06/11/ Moule R and Hoskin P. Non-surgical treatment of localized prostate cancer. Surg Oncol 2009;18; Moule R and Hoskin P. Non-surgical treatment of localized prostate cancer. Surg Oncol 2009;18; Pisansky T, Gold D, Furutani K et al. High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer. Mayo Clin Proc 2008;83(12): Pisansky T, Gold D, Furutani K et al. High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer. Mayo Clin Proc 2008;83(12): Minimizes dose to surrounding tissues/spares surrounding organs: 1.Pisansky T, Gold D, Furutani K et al. High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer. Mayo Clin Proc 2008;83(12): Pisansky T, Gold D, Furutani K et al. High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer. Mayo Clin Proc 2008;83(12): Phan T, Syed A, Puthawala A et al. High dose rate brachytherapy as a boost for the treatment of localized prostate cancer. Jnl Urol 2006;177: Phan T, Syed A, Puthawala A et al. High dose rate brachytherapy as a boost for the treatment of localized prostate cancer. Jnl Urol 2006;177: Fatyga M, Williamson JF, Dogan N, et al. A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer: a radiobiological modeling study. Med Phys 2009;36(9): Fatyga M, Williamson JF, Dogan N, et al. A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer: a radiobiological modeling study. Med Phys 2009;36(9): Hermesse J, Biver S, Jansen N, et al. A dosimetric selectivity intercomparison of HDR brachytherapy, IMRT and helical tomotherapy in prostate cancer radiotherapy. Strahlenther Onkol. 2009;185:736-42Hermesse J, Biver S, Jansen N, et al. A dosimetric selectivity intercomparison of HDR brachytherapy, IMRT and helical tomotherapy in prostate cancer radiotherapy. Strahlenther Onkol.2009;185: Back to key messages

21 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Well tolerated with minimized side effects (contd) Minimizes toxicity and side effects, optimizes QoL: 1.Moule R and Hoskin P. Non-surgical treatment of localized prostate cancer. Surg Oncol 2009;18; Moule R and Hoskin P. Non-surgical treatment of localized prostate cancer. Surg Oncol 2009;18; Henderson A, Laing R and Langley S. Quality of life following treatment for early prostate cancer: Does low dose rate (LDR) brachytherapy offer a better outcome? A review. Eur Urol 2004;45: Henderson A, Laing R and Langley S. Quality of life following treatment for early prostate cancer: Does low dose rate (LDR) brachytherapy offer a better outcome? A review. Eur Urol 2004;45: Pickles T, Keyes M, Morris W et al. Brachytherapy or conformal external radiotherapy for prostate cancer: A single institution matched-pair analysis. Int J Radiat Oncol Biol Phys 2010;76(1):43-49.Pickles T, Keyes M, Morris W et al. Brachytherapy or conformal external radiotherapy for prostate cancer: A single institution matched-pair analysis. Int J Radiat Oncol Biol Phys 2010;76(1): Buron C, Le Vu B, Cosset J-M et al. Brachytherapy versus prostatectomy in localized prostate cancer: Results of a French multicenter prospective medico-economic study. Int J Radiat Oncol Biol Phys 2007;67(3): Buron C, Le Vu B, Cosset J-M et al. Brachytherapy versus prostatectomy in localized prostate cancer: Results of a French multicenter prospective medico-economic study. Int J Radiat Oncol Biol Phys 2007;67(3): Frank S, Pisters L, Davis J et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. Jnl Urol 2007;177: Frank S, Pisters L, Davis J et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. Jnl Urol 2007;177: Malcolm JB et al. Quality of life after open or robotic prostatectomy, cryoablation or brachytherapy for localized prostate cancer. J. Urol : Malcolm JB et al. Quality of life after open or robotic prostatectomy, cryoablation or brachytherapy for localized prostate cancer. J. Urol : Back to key messages

22 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Well tolerated with minimized side effects (contd) Urinary function: 1.Moule R and Hoskin P. Non-surgical treatment of localized prostate cancer. Surg Oncol 2009;18; Moule R and Hoskin P. Non-surgical treatment of localized prostate cancer. Surg Oncol 2009;18; Pickles T, Keyes M, Morris W et al. Brachytherapy or conformal external radiotherapy for prostate cancer: A single institution matched-pair analysis. Int J Radiat Oncol Biol Phys 2010;76(1):43-49.Pickles T, Keyes M, Morris W et al. Brachytherapy or conformal external radiotherapy for prostate cancer: A single institution matched-pair analysis. Int J Radiat Oncol Biol Phys 2010;76(1): Frank S, Pisters L, Davis J et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. Jnl Urol 2007;177: Frank S, Pisters L, Davis J et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. Jnl Urol 2007;177: Pinkawa M, Asadpour B, Piroth M et al. Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer – a matched- pair comparison. Radiother Oncol 2009;91: Pinkawa M, Asadpour B, Piroth M et al. Health-related quality of life after permanent I-125 brachytherapy and conformal external beam radiotherapy for prostate cancer – a matched- pair comparison. Radiother Oncol 2009;91: Ash D, Bottomley D, al-Qaisieh B et al. A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer. Radiother Oncol 2007;84(2): Ash D, Bottomley D, al-Qaisieh B et al. A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer. Radiother Oncol 2007;84(2): Back to key messages

23 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Patient-centered with minimized impact on QoL Prostate brachytherapy allows for significantly shorter treatment times, often on an out- patient basis, compared to EBRT – day(s) compared to weeks, and shorter recovery times compared to radical prostatectomy, with minimal impact on functional outcomes and quality of life 1.Frank S, Pisters L, Davis J et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. Jnl Urol 2007;177: Frank S, Pisters L, Davis J et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. Jnl Urol 2007;177: Stone N and Stock R. Long-term urinary, sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years. Urol 2007;69; Stone N and Stock R. Long-term urinary, sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years. Urol 2007;69; Ash D, Bottomley D, al-Qaisieh B et al. A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer. Radiother Oncol 2007;84(2): Ash D, Bottomley D, al-Qaisieh B et al. A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer. Radiother Oncol 2007;84(2): Hoskin P and Bownes P. Innovative technologies in radiation therapy: Brachytherapy. Semin Radiat Oncol 2006;16: Hoskin P and Bownes P. Innovative technologies in radiation therapy: Brachytherapy. Semin Radiat Oncol 2006;16: Grills I, Martinez A, Hollander M et al. High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds. Jnl Urol 2004;171: Grills I, Martinez A, Hollander M et al. High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds. Jnl Urol 2004;171: Back to key messages

24 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Patient-centered with minimized impact on QoL (contd) Minimally invasive, shorter recovery time: 1.Holloway C, Hsu I. Albert C et al. Prostate brachytherapy. In Devlin, Brachytherapy: Applications and techniques. Philadelphia, PA. LWW Holloway C, Hsu I. Albert C et al. Prostate brachytherapy. In Devlin, Brachytherapy: Applications and techniques. Philadelphia, PA. LWW Hall J, Boyd J, Lippert M et al. Why patients choose prostatectomy or brachytherapy for localized prostate cancer: Results of a descriptive survey. Urol 2003;61: Hall J, Boyd J, Lippert M et al. Why patients choose prostatectomy or brachytherapy for localized prostate cancer: Results of a descriptive survey. Urol 2003;61: Prostate Brachytherapy Advisory Group. Available at: Accessed 06/11/09. Back to key messages

25 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Patient-centered with minimized impact on QoL (contd) Shorter treatment duration – reduced disruption to daily life: 1.Frank S, Pisters L, Davis J et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. Jnl Urol 2007;177: #Frank S, Pisters L, Davis J et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. Jnl Urol 2007;177: Hoskin P and Bownes P. Innovative technologies in radiation therapy: Brachytherapy. Semin Radiat Oncol 2006;16: Hoskin P and Bownes P. Innovative technologies in radiation therapy: Brachytherapy. Semin Radiat Oncol 2006;16: Holloway C, Hsu I. Albert C et al. Prostate brachytherapy. In Devlin, Brachytherapy: Applications and techniques. Philadelphia, PA. LWW Holloway C, Hsu I. Albert C et al. Prostate brachytherapy. In Devlin, Brachytherapy: Applications and techniques. Philadelphia, PA. LWW Prostate Brachytherapy Advisory Group. Available at: Accessed 06/11/09. Back to key messages

26 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Patient-centered with minimized impact on QoL (contd) Reduced side effects and impact on functional outcomes: 1.Frank S, Pisters L, Davis J et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. Jnl Urol 2007;177: Frank S, Pisters L, Davis J et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. Jnl Urol 2007;177: Stone N and Stock R. Long-term urinary, sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years. Urol 2007;69; Stone N and Stock R. Long-term urinary, sexual and rectal morbidity in patients treated with Iodine-125 prostate brachytherapy followed up for a minimum of 5 years. Urol 2007;69; Ash D, Bottomley D, al-Qaisieh B et al. A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer. Radiother Oncol 2007;84(2): Ash D, Bottomley D, al-Qaisieh B et al. A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localized prostate cancer. Radiother Oncol 2007;84(2): Roeloffzen EM, Lips IM, van Gellekom MP, et al. Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer. Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print].Roeloffzen EM, Lips IM, van Gellekom MP, et al. Health-related quality of life up to six years after 125I brachytherapy for early-stage prostate cancer. Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print]. 5.Ferrer M, Suarez JF, Guedea F, et al. Health-related quality of life 2 years after treatment with radical prostatectomy, prostate brachytherapy, or external beam radiotherapy in patients with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 2008;72(2): Ferrer M, Suarez JF, Guedea F, et al. Health-related quality of life 2 years after treatment with radical prostatectomy, prostate brachytherapy, or external beam radiotherapy in patients with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 2008;72(2): Malcolm JB et al. Quality of life after open or robotic prostatectomy, cryoablation or brachytherapy for localized prostate cancer. J. Urol : Malcolm JB et al. Quality of life after open or robotic prostatectomy, cryoablation or brachytherapy for localized prostate cancer. J. Urol : Back to key messages

27 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Patient-centered with minimized impact on QoL (contd) Lower personal and hospital costs: 1.Frank S, Pisters L, Davis J et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. Jnl Urol 2007;177: Frank S, Pisters L, Davis J et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. Jnl Urol 2007;177: Hoskin P and Bownes P. Innovative technologies in radiation therapy: Brachytherapy. Semin Radiat Oncol 2006;16: Hoskin P and Bownes P. Innovative technologies in radiation therapy: Brachytherapy. Semin Radiat Oncol 2006;16: Buron C, Le Vu B, Cosset J-M et al. Brachytherapy versus prostatectomy in localized prostate cancer: Results of a French multicenter prospective medico-economic study. Int J Radiat Oncol Biol Phys 2007;67(3): Buron C, Le Vu B, Cosset J-M et al. Brachytherapy versus prostatectomy in localized prostate cancer: Results of a French multicenter prospective medico-economic study. Int J Radiat Oncol Biol Phys 2007;67(3): Back to key messages

28 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Optimized healthcare resources Prostate brachytherapy (LDR seed therapy and HDR brachytherapy provides a key solution in optimizing healthcare resources, delivering clinical efficacy and patient-centered therapy on a cost-effective basis: 1.Institute for Clinical and Economic Review. Management Options for Low-Risk Prostate Cancer: A Report on Comparative Effectiveness and Value. 2010Institute for Clinical and Economic Review. Management Options for Low-Risk Prostate Cancer: A Report on Comparative Effectiveness and Value Modern radiotherapy with low investment costs: 1.Pötter R. Image–guided brachytherapy sets benchmarks in advanced radiotherapy. Radiother Oncol 2009;91: Pötter R. Image–guided brachytherapy sets benchmarks in advanced radiotherapy. Radiother Oncol 2009;91: Institute for Clinical and Economic Review. Management Options for Low-Risk Prostate Cancer: A Report on Comparative Effectiveness and Value. 2010Institute for Clinical and Economic Review. Management Options for Low-Risk Prostate Cancer: A Report on Comparative Effectiveness and Value Back to key messages

29 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Optimized healthcare resources (contd) Cost effectiveness vs. frequently used alternative modalities: 1.ICER. Accessed http://www.icer-review.org/index.php/final-harmonized-report html 2.Brandeis J, Pashos C, Henning J et al. A nationwide charge comparison of the principal treatments for early stage prostate carcinoma. Can 2000;89: Brandeis J, Pashos C, Henning J et al. A nationwide charge comparison of the principal treatments for early stage prostate carcinoma. Can 2000;89: Brachytherapy offers opportunity to maximize radiotherapy department resources: 1.Koukourakis G, Kelekis N, Armonis V et al. Brachytherapy for prostate cancer. Adv Urol 2009: Article ID Koukourakis G, Kelekis N, Armonis V et al. Brachytherapy for prostate cancer. Adv Urol 2009: Article ID Back to key messages

30 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Solid heritage Prostate cancer has been treated with permanent implants (LDR seed therapy) since the 1960s. It has become the standard of care in many countries through its disease specific survival and unrivalled patient benefits: 1.Grimm P and Sylvester J. Advances in brachytherapy. Rev Urol 2004;6 (Suppl 4):S37-S48.Grimm P and Sylvester J. Advances in brachytherapy. Rev Urol 2004;6 (Suppl 4):S37-S48. 2.Koukourakis G, Kelekis N, Armonis V et al. Brachytherapy for prostate cancer. Adv Urol 2009: Article ID Koukourakis G, Kelekis N, Armonis V et al. Brachytherapy for prostate cancer. Adv Urol 2009: Article ID Stock R, Cesaretti J and Stone N. Disease-specific survival following the brachytherapy management of prostate cancer. Int J Radiat Oncol Biol Phys 2006;64(3): Stock R, Cesaretti J and Stone N. Disease-specific survival following the brachytherapy management of prostate cancer. Int J Radiat Oncol Biol Phys 2006;64(3): Heritage: 1.Grimm P and Sylvester J. Advances in brachytherapy. Rev Urol 2004;6 (Suppl 4):S37-S48.Grimm P and Sylvester J. Advances in brachytherapy. Rev Urol 2004;6 (Suppl 4):S37-S48. 2.Holloway C, Hsu I. Albert C et al. Prostate brachytherapy. In Devlin, Brachytherapy: Applications and techniques. Philadelphia, PA. LWW Holloway C, Hsu I. Albert C et al. Prostate brachytherapy. In Devlin, Brachytherapy: Applications and techniques. Philadelphia, PA. LWW Back to key messages

31 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Solid heritage (contd) Global acceptance: 1.European Association of Urology Guidelines on Prostate Cancer. Available at: Accessed 02/11/ American Urology Association Guideline for the Management of Locally Advanced Prostate Cancer. Available at: reports/proscan07/content.pdf Accessed 02/11/09. reports/proscan07/content.pdf 3. National Health and Medical Research Council Clinical Practice Guidelines: Evidence-based recommendations for the management of localised prostate cancer. Available at: Accessed 04/11/09. Evidence based: 1.Pubmed. Search: Prostate cancer brachytherapy. Available at: Accessed Continued advances: 1.Holloway C, Hsu I. Albert C et al. Prostate brachytherapy. In Devlin, Brachytherapy: Applications and techniques. Philadelphia, PA. LWW Holloway C, Hsu I. Albert C et al. Prostate brachytherapy. In Devlin, Brachytherapy: Applications and techniques. Philadelphia, PA. LWW Back to key messages

32 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Prostate brachytherapy: Solid heritage (contd) Constant technique development means better patient QoL: 1.Holloway C, Hsu I. Albert C et al. Prostate brachytherapy. In Devlin, Brachytherapy: Applications and techniques. Philadelphia, PA. LWW Holloway C, Hsu I. Albert C et al. Prostate brachytherapy. In Devlin, Brachytherapy: Applications and techniques. Philadelphia, PA. LWW Pisansky T, Gold D, Furutani K et al. High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer. Mayo Clin Proc 2008;83(12): Pisansky T, Gold D, Furutani K et al. High-dose-rate brachytherapy in the curative treatment of patients with localized prostate cancer. Mayo Clin Proc 2008;83(12): Grimm P and Sylvester J. Advances in brachytherapy. Rev Urol 2004;6 (Suppl 4):S37-S48.Grimm P and Sylvester J. Advances in brachytherapy. Rev Urol 2004;6 (Suppl 4):S37-S48. Back to key messages

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34 FOR INTERNAL USE ONLY _ DO NOT DISTRIBUTE Back to citations


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