[Interstitial brachytherapy--a minimal invasive urological option for treatment of prostate cancer of increasing importance].
As an alternative to a radical prostatectomy with complications reducing the quality of life because of incontinence of urine and erectile dysfunction, the insertion of radioactive sources into the prostate was established in the USA and evaluated by accompanying studies at the beginning of the eighties. The patient has the advantage of minimal-invasive character, the possibility of outpatient treatment and the lower operative morbidity as well as reduced complications. In the locally limited "low-risk" stage (pT1a - pT2c), the American Society for Urology judges it equieffective as a curative treatment as regards the survival period. Although there are long-term studies with a follow-up of 13 years, in Germany we are not able to give our opinion finally, but it can be assumed to be as equally good. Considering the demographic development, one has to expect an increase in this cancer, which today already has the highest cancer rate in men in Germany. The improved diagnosis will lead to an increase in treatments and younger men will be examined. As a result there will be more curable cases and an improvement or even prolongation of the survival period. The trend seen in the USA indicates a rise in this treatment in Germany as well. After a terminological definition of the expression and a presentation of the brachytherapy-technique, the range of actual therapeutical options of prostate cancer and the variations of brachytherapy are shown and compared as far as their efficiency is concerned. Uncertainties in the evaluation of medical necessity are discussed but also contradictions and diversities in the opinions on the mode of accounting.
Slany
E
E
Abteilung für Medizinische Beratung der Deutschen Krankenversicherung AG.
Senger
V
V
Maurer
U
U
Zumbè
J
J
D000328:Adult; D000368:Aged; D001918:Brachytherapy; D003430:Cross-Sectional Studies; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D015996:Survival Rate; D016896:Treatment Outcome