In addition, modern techniques in radiation therapy also lead to a better preserved quality of life.
Prostate cancer is the most frequently occurring malignant tumor in men. Each year, 58,000 German men are diagnosed with prostate cancer and 11,000 die from the disease.
Rates of prostate cancer detection vary widely across the world and although it is one of the most common cancer types among men, in early stages, there are no typical symptoms. As a result, because patients do not undergo therapy, some of these men die unnecessarily.
“Only if prostate cancer is detected in an early stage, there will be an optimal chance for cure”, says urologist Dr. Pedram Derakhshani of the West German Prostate Centre in Cologne.
With targeted preventive screening, early stages of the disease can be detected in more than 90 percent of all cases and can be treated successfully.
Radical prostate surgery, or complete removal of the organ and nearby tissues, was believed to be the only successful treatment of prostate cancer despite of a high complication rate. However, 60 to 90 percent of patients become impotent after the procedure and up to 20 per cent of the patients suffer urinary incontinence.
Nowadays, brachytherapy, which is also known as interstitial radiation therapy or seed implant therapy, offers an equal chance of complete recovery with minimal side effects.
“Internal radiotherapy to treat prostate cancer has the advantage of preserving the prostate and lowering the risks of side effects of therapy. We can avoid surgery in many cases,” says Dr. Stephan Neubauer, leading urologist at the West-German Prostate Center.
“This is one of the reasons why in the US, where brachytherapy has been performed for over 30 years, rates of patients receiving brachytherapy have increased markedly,” he adds.
Brachytherapy destroys the tumor while preserving the prostate
At the beginning of the treatment, the exact size and volume of the prostate will be determined by ultrasound. Based on the data, an optimal radiation plan will be designed by the radiation therapist.
During the seed implantation procedure, the urologist implants up to 80 radioactive seeds, which are a few millimetres in size, with a hollow needle into the prostate. This is done under ultrasound guidance.
“The seeds will remain permanently within the prostate. Their size is very small so that they will not be felt or noticed by the patient”, explains Dr. Derakhshani.
Prostate tumours are destroyed internally through high doses of precisely targeted radiation.
While seed implantation is used in the treatment of early diagnosed prostate carcinoma, the HDR (high dose rate) afterloading procedure is a more effective and meaningful therapy for advanced and aggressive prostate cancer.
In this type of brachytherapy, a highly active radioactive source is temporarily placed into the prostate. The treatment is repeated two to three times at one-week intervals at the clinic and will in most cases be combined with an external radiation therapy.
“The broad spectrum of therapies allows us, depending on the size and type of tumour, to determine the most effective and minimally invasive treatment strategy for each individual patient,” says Dr. Neubauer.
A benefit of internal radiation is that the patient clearly experiences fewer side effects. In addition, the recovery time is relatively short and patients can resume professional and leisure activities few days after the procedure.
Laser treatment also for big prostates
Frequent urination, a hesitant and interrupted weak stream and discomforting urgency of leaking and dribbling are a nightmare for many men. These side effects result most often from a benign enlargement of the prostate.
Almost every other man over the age of 50 is affected by these conditions, with benign prostate hyperplasia the most frequently occurring disease in men.
“Various options for the treatment of benign prostate hyperplasia are available,” says Dr. Derakhshani.
The type of procedure selected depends on the subjective symptoms of the patient and the size of the prostate. In the initial phase, medication can be prescribed to reduce the swelling and to relax the prostate tissue. Later, only surgical procedures can relieve the symptoms.
Aside from the standard prostate resection, the West German Prostate Center offers two innovative procedures of modern laser therapy. These procedures remove obstructive prostate tissue by vaporisation.
Advantages of these gentle laser treatments are minimal invasiveness, reduced blood loss and quick recovery. The procedure is done with a laser to minimise side effects and complications. Patients with cardiovascular diseases and increased bleeding tendency will benefit in particular from laser therapy.
The procedure takes only 45 to 60 minutes and is done as a short-stay therapy. “With the high power diode laser we can also treat large size prostates weighing more than 100 grams. Up to now, such patients had to be treated by open prostate surgery, which often caused extensive blood loss,” explains Dr. Derakhshani.
Dr. Derakhshani and Dr. Neubauer have founded the West German Prostate Centre in Cologne in 2002. They have performed more than 1,500 seed implantations and 2,500 afterloading therapies treating localised prostate carcinomas in the last eight years, as well as 800 laser therapies since 2004.
Of the German clinics that offer both forms of brachytherapy, the Prostate Centre has the longest experience and has one of the highest caseloads of patients with prostate disease in Europe. About 90 percent of its therapies involve brachytherapy, which has greatly improved over the last 20 years.
Thirty percent of patients are other Europeans or from abroad. In addition to German and English, Dr. Derakhshani speaks Farsi and Dr. Neubauer speaks Dutch and French. Fifteen percent of patients are consulted in languages other than German.
After treatment, the patients’ doctors continue with follow-up examinations and they receive scheduled controls at regular intervals. The centre also asks patients to fill in questionnaires over several years on their condition.
The centre is accustomed to handling patients from around the world. For more complicated cases, patients can stay two to three days in the private hospital where the clinic is located. The facility provides broad possibilities for additional treatments, including surgery.
For more information about the Prostate Centre and brachytherapy, please visit www.wpz-koeln.de