Minimally invasive radiotherapy for prostate cancer

LDR brachytherapy, Munich (seed implantation)

Introduction

Prostate cancer is one of the most common malignant tumor diseases in men worldwide and the third most common cause of cancer-related deaths. In Central Europe alone, more than 300,000 men develop prostate cancer each year. If the cancer is diagnosed early and is still limited to the prostate, there is an excellent and therefore very high chance of cure.

Diagnosis of prostate cancer in Munich

In the early stages, prostate cancer usually does not cause any symptoms. Sometimes, as a result of the enlargement of the organ, symptoms such as frequent urination, urination at night, a weakened urinary stream or even blood in the urine may occur. Precisely because there are rarely any noticeable symptoms or pain at the beginning of prostate cancer, we recommend that men - in accordance with the International Urological Guidelines – annually visit a urologist for a prostate cancer screening examination from the age of 45 if they have a family history of the disease, otherwise from the age of 50. In addition to the medical history and the physical examination, we routinely perform a urinalysis, a transrectal ultrasound using the latest 3D technology and a PSA determination in the blood serum. If, in particular, the PSA value, sonography (ultrasound examination) or the finger-guided (digital) palpation reveal abnormalities in the prostate, several tissue samples (biopsies) must be taken from the prostate in order to definitively confirm the suspicion of cancer histopathological (pathological tissue changes). We perform this biopsy under general anesthesia with the aid of the ultra-modern image fusion technique (fusion biopsy). Only after precisely confirmed cancer diagnosis can appropriate cancer therapy take place.

Minimally invasive therapy technique: the LDR brachytherapy (low-dose-rate seed implantation) Munich

A very modern and innovative treatment method for the treatment of prostate cancer in urology is the LDR brachytherapy (permanent seed implantation). In a one-time therapy session under general anesthesia, mini-radiator implants, "seeds", are placed in the prostate with high precision under X-ray/ultrasound and computer control using tiny hollow needles in order to ensure precise irradiation of the cancer cells. The range of the emitted gamma radiation of a single seed in the tissue is only a few millimeters. This procedure thus guarantees a strictly "individualized radiation cancer therapy" adapted to the patient, with maximum protection of the urinary bladder, the rectum and the vascular nerve tracts from a barely measurable scatter radiation. Seed implantation is one of the minimally invasive therapeutic procedures for the treatment of prostate cancer. Its implementation - usually performed on an outpatient basis - is regulated by strict legal personnel and spatial requirements.

We perform brachytherapy at the Munich-Planegg Urological Clinic. You can find more information below.

With an overall low side effect profile, increased urinary urgency symptoms may occur temporarily. Radiation-induced changes in the rectum and urinary bladder are rare compared to external beam radiotherapy. Urinary incontinence occurs in less than one percent of cases. Potency remains unaffected in the short term with seed implantation. Seven years after implantation, approximately 30 to 40 percent of treated patients experience a decrease in sexual performance (impotence).

Permanent LDR brachytherapy is often safer and gentler than external radiation or so-called temporary (temporary) high-dose brachytherapy (HDR), in which a high dose is administered in a short time within minutes or a few hours. In addition, there is no radiation exposure to family members.

According to the results of international studies, brachytherapy is now considered an established, highly effective therapeutic procedure in the organ-confined cancer stage.

Previous therapy methods, such as surgical removal of the prostate (radical prostatectomy-RPE) or external radiation (ERBT/IMRT), do not show better cure rates in the treatment of prostate cancer in comparable tumor stages, contrary to other claims according to the international literature. With over 1,800 treatments within the last 18 years, Dr. Meisse is one of the most experienced users of brachytherapy in German-speaking countries.

In summary, seed implantation offers the following advantages:

• LDR brachytherapy is a minimally invasive prostate cancer therapy that can be performed on an outpatient basis. This means the patient can leave the clinic again after a 60-minute therapy period.
• Due to the good data situation, brachytherapy has meanwhile been able to establish itself in the USA and Europe as one of currently three preferred treatment procedures for the treatment of localized prostate carcinoma compared to external radiation and radical prostate surgery.
• Comparing the currently available 10 - 15-year follow-up data after radical surgical prostate removal and after external beam radiation with regard to cancer cure rate, brachytherapy shows absolutely equally good and equally effective results as surgical prostate removal.
• The risk of urinary incontinence (involuntary loss of urine) as a result of an injury to the external bladder sphincter is virtually eliminated with brachytherapy, in contrast to surgical removal of the prostate; urinary incontinence is maintained in all cases.
• The spontaneous erectile function (potency rate) of the male penis is maintained in approximately 50-60% of cases after brachytherapy, while according to the literature, male impotence can occur in up to 80% of cases after prostate surgery.
• The short duration of therapy and the low intra- and postoperative complication rate allow the patient a rapid autonomy in everyday life with an early postoperative resocialization.
• Due to the good results, LDR brachytherapy (low-dose-rate seed implantation) is also a serious therapy alternative for locally advanced prostate carcinomas of stages equal to/larger than Gleason 7a/7b as monotherapy or in combination with adjuvant (additional) reduced external dose irradiation.

Brachytherapy as a treatment requires only one therapy session in contrast to external beam radiation, where the patient must be irradiated once a day for 4 - 6 weeks, which is very time consuming and often tedious for the patient.

Alternative therapies Munich

• Radical surgical prostate removal (RPE)
• External irradiation (ERBT/IMRT)
• HDR brachytherapy

Treatment in the Urological Clinic Munich-Planegg

The Urological Clinic Munich Planegg is a specialist urological clinic of Fachkliniken München AG, where the entire spectrum of surgical urology is offered. For treatment of localized prostate cancer, the clinic is one of the few clinics in Germany to also offer the S3 guideline-compliant interstitial radiotherapy of prostate cancer, the low-dose rate brachytherapy (LDR brachytherapy), also known as permanent seed implantation.

Dr. Friedemann Meisse is a specialist in urology, has been a contract physician in private practice in Munich since 1998 and has specialized in the treatment of prostate cancer with brachytherapy for prostate cancer since 2002. Since 2015, Dr. Meisse has also been the head physician of the brachytherapy department at the Planegg Urological Clinic.

With over 1,800 treatments, Dr. Friedemann Meisse from Munich is one of the most experienced brachytherapists nationwide.

For this highly specialized therapy, patients from all over Germany are presented to Dr. Meisse by specialists in urology and radiation therapy for targeted brachytherapy at the Urological Clinic in Munich Planegg, as well as in his practice.

As previously stated, the performance of this highly specialized intervention is bound by strict legal personnel and spatial requirements.

In addition to the proven experience, the special expertise of the State Medical Association as well as a personal handling permit and site permit from the State Office for the Environment are prerequisites.

Dr. Friedemann Meisse is one of the few urologists in Germany to hold a radiation protection certificate for brachytherapy with iodine seeds and is therefore authorized to carry out this specialist therapy.

He is also the radiation protection officer of the Urological Clinic Planegg for the medical field of brachytherapy. The personal and site-related handling permit for radioactive substances as well as the strict requirements for the spatial and technical equipment require that the therapy must take place at the Urological Clinic Planegg.