title: [Brachytherapy in prostatic cancer].
abstract: BACKGROUND
  Brachytherapy is increasingly used in the treatment of early prostate cancer, but has not been implemented as a treatment option in Norway. Recent advances in imaging techniques and the radiation technology itself has facilitated improvements in and better standardisation of brachytherapy.
  
  
  METHODS
  An group of expert assisted the Norwegian Centre for Health Technology Assessment (SMM) in a systematic review of the evidence on the clinical effectiveness of prostate brachytherapy. The literature was identified by a defined search strategy, and assessed for relevance and validity. Only controlled or comparative studies were included in the review.
  
  
  RESULTS
  There were no randomized controlled trials or large prospective studies. Many of the relevant studies were of poor validity. None of the included studies had sufficient follow-up for overall or disease free survival. There were no differences between brachytherapy, external beam therapy or radical prostatectomy in disease free survival (PSA measures) or in rates of complications.
  
  
  CONCLUSIONS
  There is a lack of valid data from large prospective studies on the clinical effectiveness of brachytherapy. On the other hand, the clinical effectiveness of radical prostatectomy and external beam radiotherapy is also poorly documented. Results from one large randomized controlled trial comparing radical prostatectomy with brachytherapy in the USA will not be available within the next ten years.
authors.affiliation: Senter for medisinsk metodevurdering SINTEF Unimed Postboks 124 Blindern 0314 Oslo. inger.n.norderhaug@sintef.no
authors.forename: Inger
authors.initials: I
authors.lastname: Norderhaug
authors.forename: Truls Bjerklund
authors.initials: TB
authors.lastname: Johansen
authors.forename: Olav
authors.initials: O
authors.lastname: Dahl
authors.forename: Per A
authors.initials: PA
authors.lastname: Høisaeter
authors.forename: Reino
authors.initials: R
authors.lastname: Heikkilä
authors.forename: Olbjørn
authors.initials: O
authors.lastname: Klepp
authors.forename: Dag Rune
authors.initials: DR
authors.lastname: Olsen
authors.forename: Ivar S
authors.initials: IS
authors.lastname: Kristiansen
authors.forename: Håkon
authors.initials: H
authors.lastname: Waehre
mesh_terms: D001918:Brachytherapy / Q000379:methods; D018849:Controlled Clinical Trials as Topic; D019317:Evidence-Based Medicine; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000532:radiotherapy*