Low risk prostate cancer
The case of patients who have low risk prostate cancer, with PSA below 10ng/ml and the Gleason scoreon ≦6, are categorized as low risk prostate cancer.The Prostate Cancer Results Study Group, PCRSG, is an international team of doctors and medical professionals of all disciplines.They offer useful information to the prostate cancer patients to show which prostate cancer treatment are most effective at eliminating localized cancer, and preventing the cancer from coming back.See the low risk data at Prostate Cancer Results Study Group (PCRSG)
For low risk prostate cancer, there are many types of treatments, such as operation and external radiation that could provide relatively good results.Contemporary seed implantation techniques in the world wide data offers high PSA failure free rate for low risk prostate cancer.However, most low risk prostate cancer is known not progressing in a short period. Therefore, we recommend active surveillance or watchful waiting as a first step for low risk patients. If your PSA is rising or risk category is elevated in this follow-up. We are ready to conduct seed implantation monotherapy.
As described in the section of intermediate risk, our seed implantation monotherapy (brachytherapy) at SUMS provides high radiation dose (Equivalent to 100 Gy by external beam radiation therapy) safely.By conducting the high quality seed implantation, risk of recurrence in our department is very minimum.
High Risk Prostate Cancer
Cancers, including above 20ng/ml on PSA and/or the Gleason score 8-10 and /or T3 disease (Tumor with extracapsular extension) are called higher risk prostate cancer. Thus, high risk prostate cancer is a category of prostate cancer that implies an aggressive tumor and/or a high tumor volume. Importantly, insufficient management of the high-risk prostate cancer patients have potential to result in metastasis or cancer death.So far, high risk prostate cancer has been considered difficult prostate cancer because of its higher recurrence rate using standard treatments. See the high risk data at Prostate Cancer Results Study Group (PCRSG)
By applying short term hormonal treatment (ADT: androgen deprivation therapy), high dose of radiation that combines brachytherapy with external radiation therapy has shown excellent outcome for high risk prostate cancer (ADT+Seeds+EBRT)
At SUMS, we deliver high BED (biologically effective dose) of 220Gy (for high risk patients and very high risk patients including seminal vesicle invasion (T3b) in this combination modality. BED is an equation to compare different type or combined radiotherapy advocated by Prof. Stock.
BED of 220Gy is equivalent to 110Gy for standard EBRT. By using this high dose combination therapy, our most recent data has shown 5 year PSA failure free rate of 95.2% for high risk and very high risk prostate cancer including some of N1 disease (Journal of Contemporary Brachytherpy 2017).
Intermediate Risk Prostate Cancer
Prostate cancers which do not belong to low risk nor high risk prostate cancer are categorized into intermediate risk prostate cancer. Generally, cancers with PSA 10 to 20ng/ml and/or the Gleason score 7 and/or T2b, T2c cancer fit into this group. See the intermediate risk data at Prostate Cancer Results Study Group (PCRSG)http://www.pctrf.org/intermediate-risk/
Seeds alone (brachytherapy mono therapy) or seeds and EBRT (brachytherapy in combination with EBRT) shows better outcome than surgery or EBRT.When we apply seeds alone mono therapy for intermediate risk prostate cancer, sufficiently high radiation dose must be delivered to eradicate prostate cancer. At SUMS, we currently treat intermediate risk prostate cancer with high dose seed implantation mono therapy without using hormonal therapy (BED of 200Gy).This high radiation dose single brachytherapy is delivered by D90=190-200 Gy of I125 seeds implantation (D90 means the amount of seeds radiated 90% of the prostrate). This radiation dose is equivalent to 100 Gy by EBRT or IMRT.Also, external radiation may be offered for some patients with intermediate risk cases that are judged to be close to high risk cancer. We carefully operate the treatments so as not to have recurrence in either case - treating with brachytherapy mono therapy or brachytherapy in combination with external radiation.