Aussie men are missing out on innovative prostate cancer treatment

Prostate cancer is Australia’s most commonly diagnosed men’s cancer, affecting nearly a quarter of a million Aussie men with 66 men diagnosed every day.¹

Early screening and detection of prostate cancer is crucial in ensuring men get the treatment they need. Concerningly though, Australian men diagnosed with prostate cancer are being denied access to an innovative treatment on Medicare.

Low-dose rate brachytherapy (LDR-brachytherapy) used in combination with external beam radiation therapy is considered a global standard of care for men diagnosed with higher-risk prostate cancer.^2-5

Seed brachytherapy alone (monotherapy) treatment in Intermediate risk prostate cancer has been approved for use in Australia by the Therapeutic Goods Administration (TGA) for many years now.^{6, 7}

However, the combination treatment is not covered by Medicare for men with higher-risk prostate cancer – where the cancer may have spread outside the prostate and hence the rationale for such treatment.⁸ To determine the benefits of such treatment in high-quality studies take years to complete. A not-so-recent study has demonstrated the effectiveness of this treatment approach and has taken years to complete. This study by Morris et al. has demonstrated the benefit of this treatment approach and is now considered a standard treatment option in many first-world counties.

A shocking decision was made by the Medical Services Advisory Committee (MSAC), who have now twice rejected this combination treatment to be covered on Medicare for men with high-risk or high-intermediate risk prostate cancer.

This means this innovative treatment is only available to those men who can afford it. Furthermore and even more frustrating is that a small subset of patients can receive this treatment if they are a high intermediate risk but have a PSA <10. This was approved by MSAC many years ago but applies to only very small subset of patients. We now have a situation whereby the treatment is approved and deemed safe to use in a very small subset of patients, yet the men who are most likely to benefit from this treatment are denied access.

How the combination treatment works

Low dose rate brachytherapy (LDR-brachytherapy) is a minimally invasive prostate cancer treatment involving the highly targeted insertion of permanent radioactive ‘seeds’ directly into the prostate, which gives off localised radiation over several months to kill cancer cells.⁹

External beam radiation therapy is where machines outside of the body are used to deliver high-energy radiation to cancerous tumours.¹⁰

LDR-brachytherapy, combined with external beam radiation therapy, has been shown to be a safe and effective treatment option for higher-risk prostate cancer.¹¹

Treatment utilising LDR-brachytherapy is associated with low risk of long-term side effects. Both urinary incontinence and bowel function commonly return to near pre-LDR-brachytherapy treatment levels after one year, and erectile function is often preserved⁹, helping to maintain patient quality of life.¹²

The treatment’s success

In 2017, a landmark clinical trial investigated the use of LDR-brachytherapy in combination with external beam radiation therapy to treat men with high-risk prostate cancer. The results showed the largest improvement in cure rates ever seen in radiotherapy.¹¹

Within 24 months of the clinical trial results, medical regulators around the world approved  access to this combination treatment, making it the standard of care across the USA, UK, Canada and throughout Europe.^2-5

Yet four years on, Australian men with high-risk prostate cancer still can’t access the treatment on Medicare.

About Prostate Cancer

Prostate cancer occurs when abnormal cells develop in the prostate forming a cancerous growth. There are three main stages of prostate cancer:¹³

1. Low risk: Tumour confined to the prostate, PSA* <10
2. Intermediate risk: Tumour confined to the prostate, PSA 10-20
3. High risk: Aggressive tumour which spreads outside the prostate to nearby tissues, PSA >20, require multiple types of treatments

*Prostate-specific antigen (PSA) blood test

Prostate cancer is generally a slow-growing disease, and most men with prostate cancer can live for a long time without painful symptoms or the cancer spreading.¹³

Source: Prostate cancer is most common in older men, but the disease can also occur in men aged under 50 years.¹⁴

Prostate Cancer in Australia

Prostate cancer is Australia’s third most common cause of cancer death, claiming the lives of more than 3,500 Australian men each year.¹⁵

Prostate cancer makes up approximately 27 per cent of all new male cancer cases diagnosed each year and claims the lives of ten Australian men every day.¹⁵

Australian doctors would like to be able to offer LDR-brachytherapy in combination with external beam radiation therapy all their prostate cancer patients, but currently are unable to provide access to Medicare benefits for those with high-risk prostate cancer.

Every Australian man deserves the right to choose from all available prostate cancer treatment options approved for use in Australia and considered globally as the highest standard of care.

To back access to brachytherapy for all Australian men, visit www.backingbrachy.com.au.

Dr Joseph Bucci, MBBS FRACP FRANZCR, Radiation Oncologist, Waratah Private Hospital, Hurstville, Sydney has over 25 years’ experience in treatment of cancer and focuses on research related to Quality Assurance in Brachytherapy, with a particular interest in management of urological malignancies.

References

1. Prostate Cancer Foundation Australia. What can you do to beat prostate cancer? 2022 [cited Septemeber 2022]; Available from: https://dy2orj6fjrb16.cloudfront.net/82e20dbfc85fa400ab5921abbcb43d43.pdf.
2. Amercian Brachytherapy Society. Prostate Brachytherapy – LDR. [Septemeber 2022]; Available from: https://www.americanbrachytherapy.org/resources/for-professionals/current-applications-of-brachytherapy/prostate-brachytherapy-ldr/.
3. National institute for Health and Care Excellence (NICE). Prostate cancer: diagnosis and management. 2019 [Septemeber 2022]; Available from: https://www.nice.org.uk/guidance/ng131/chapter/recommendations#high-risk-localised-prostate-cancer.
4. European Association of Urology. Oncology Guidelines – Prostate Cancer. 2021 [Septemeber 2022]; Available from: https://uroweb.org/guideline/prostate-cancer/.
5. Chin, J., et al., Brachytherapy for Patients With Prostate Cancer: American Society of Clinical Oncology/Cancer Care Ontario Joint Guideline Update. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017. 35: p. JCO2016720466.
6. Therapeutic Goods Administration. Public Summary – Cartridge loaded I-Seed AgX100 I125 implants 2016 [Sepember 2022]; Available from: https://www.ebs.tga.gov.au/servlet/xmlmillr6?dbid=ebs/PublicHTML/pdfStore.nsf&docid=5B7A4E1E1BC2E7CBCA257F65003CA4EE&agid=(PrintDetailsPublic)&actionid=1.
7. Therapeutic Goods Administration. Public Summary – Linear Accelerator system. 2020 [Septemeber 2022]; Available from: https://www.ebs.tga.gov.au/servlet/xmlmillr6?dbid=ebs/PublicHTML/pdfStore.nsf&docid=95E1B65545996F81CA258632003CBCDC&agid=(PrintDetailsPublic)&actionid=1.
8. Prostate Foundation Australia. Understanding your cancer journey. [Septemeber 2022]; Available from: https://www.prostate.org.au/awareness/further-detailed-information/understanding-prostate-cancer-treatments-and-side-effects/understanding-your-cancer-journey/.
9. Prostate Cancer Foundation of Australia. Understanding brachytherapy for prostate cancer. 2014; Available from: https://www.prostate.org.au/media/468677/understanding-brachytherapy.pdf.
10. Cancer Australia. Prostate cancer: Treatment options. 2020 [Septemeber 2022]; Available from: https://www.canceraustralia.gov.au/cancer-types/prostate-cancer/treatment.
11. Rodda, S., et al., ASCENDE-RT: An Analysis of Treatment-Related Morbidity for a Randomized Trial Comparing a Low-Dose-Rate Brachytherapy Boost with a Dose-Escalated External Beam Boost for High- and Intermediate-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys, 2017. 98(2): p. 286-295.
12. Chao, M.W., et al., Brachytherapy: state-of-the-art radiotherapy in prostate cancer. BJU Int, 2015. 116 Suppl 3: p. 80-8.
13. Prostate cancer Foundation of Australia. What is prostate cancer? [Septemeber 2022]; Available from: https://www.prostate.org.au/awareness/general-information/understanding-prostate-cancer/what-is-prostate-cancer/.
14. Prostate Cancer Foundation of Australia. Diagnosis: Diagnosing prostate cancer in younger men. 2014 [Septemeber 2022]; Available from: https://pcfa.org.au/media/306080/2014_pcfa_younger_men_1_diagnosis.pdf.
15. Cancer Australia. Prostate cancer in Australia statistics. 2022 [September 2022]; Available from: https://www.canceraustralia.gov.au/cancer-types/prostate-cancer/statistics.