Suitability

Guide to suitability:

1. Stage T1c or T2a, Gleason of 7 or less and PSA of 15 or less, and
2. At least moderately good urine function, and
3. A prostate gland that is not very greatly enlarged.
   

Reason for criteria

This treatment option is primarily used for localized prostate cancer without obvious spread to seminal vesicles, lymph glands or bone. There are three criteria that are assessed when considering a man's suitability for a brachytherapy implant:

1. Extent and aggressiveness of the cancer. Permanent brachytherapy is suitable for men whose cancer is likely confined within or within a few millimeters of the prostate gland. This generally means men with Stage T1c (no cancer able to be felt on rectal examination) or Stage T2a (small cancer felt and contained within the gland). The aggressiveness is assessed by the Gleason score and should be Gleason 7 or less. The serum PSA test is another reflection of the extent of the cancer and should be 15 or less. The number of involved biopsy cores may also be an important factor.
   
   
2. Reasonably good urinary function. The prostate swells after the brachytherapy implant and there is a reduction in flow. Therefore a man should have at least a moderately good urinary flow and not have problems with starting urination. Men with a very poor flow have a higher chance of urinary problems after implant and are generally not suitable. Urinary function can be assessed with flow tests and questionnaires.
   
   
3. Prostate size and bone structure suitable for needle insertion. The needles are inserted under the public bone arch into the prostate. If the prostate is too big or bones too narrow then the needles may not be able to reach all the parts of the prostate. This is called pubic arch interference. This is not usually a problem if the prostate size is less than 50cc (small or only moderately enlarged) and some prostate glands 60cc are suitable. If there is a problem then often a short course of hormone treatment over about 3 months will shrink the gland and make a brachytherapy implant possible.