Prostate brachytherapy in Ghana: our initial experience

Abstract

PurposeThis study presents the experience of a brachytherapy team in Ghana with a focus on technology transfer and outcome. The team was initially proctored by experienced physicians from Europe and South Africa.Material and methodsA total of 90 consecutive patients underwent either brachytherapy alone or brachytherapy in combination with external beam radiotherapy for prostate carcinoma between July 2008 and February 2014 at Korle Bu Teaching Hospital, Accra, Ghana. Patients were classified as low-risk, intermediate, and high-risk according to the National Comprehensive Cancer Network (NCCN) criteria. All low-risk and some intermediate risk group patients were treated with seed implantation alone. Some intermediate and all high-risk group patients received brachytherapy combined with external beam radiotherapy.ResultsThe median patient age was 64.0 years (range 46-78 years). The median follow-up was 58 months (range 18-74 months). Twelve patients experienced biochemical failure including one patient who had evidence of metastatic disease and died of prostate cancer. Freedom from biochemical failure rates for low, intermediate, and high-risk cases were 95.4%, 90.9%, and 70.8%, respectively. Clinical parameters predictive of biochemical outcome included: clinical stage, Gleason score, and risk group. Pre-treatment prostate specific antigen (PSA) was not a statistically significant predictor of biochemical failure. Sixty-nine patients (76.6%) experienced grade 1 urinary symptoms in the form of frequency, urgency, and poor stream. These symptoms were mostly self-limiting. Four patients needed catheterization for urinary retention (grade 2). One patient developed a recto urethral fistula (grade 3) following banding for hemorrhoids.ConclusionsOur results compare favorably with those reported by other institutions with more extensive experience. We believe therefore that, interstitial permanent brachytherapy can be safely and effectively performed in a resource challenged environment if adequate training and proctoring is provided.

Treatment of localized prostate cancer and use of nomograms among urologists in the West Africa sub-region

“…As noted, majority of the urologists (87.5%) had referred or managed a patient with localized prostate cancer in the last one year. This support other publications that indicate that despite the majority of patients with prostate cancer presenting with advanced disease in the sub-region, there are significant numbers that present with localized disease [ 10 - 12 ] making it an important disease condition requiring to be researched into and whose management need to be improved in the West Africa sub-region. The availability of primary treatment modalities namely, radical prostatectomy, external beam radiotherapy and brachy therapy varied widely among the countries in which the urologists practiced based on their referral patterns.…”

“…Various publications have indicated the increasing use of curative procedures for localized prostate cancer in the West African sub-region such as radical prostatectomy, external beam radiation therapy and brachytherapy [ 4 , 7 , 10 - 12 ]. The decision-making process leading to the choice of a suitable method for curative treatment could be challenging.…”

Contemporary Radiation Treatment of Prostate Cancer in Africa: A Ghanaian Experience

“…Real-time transrectal ultrasound-based planning with 125 I implant sources (Bard Medical Division, Covington, GA) was used for low-dose-rate (LDR) brachytherapy to the prostate. 12 Low-risk and favorable intermediate-risk patients were prescribed 160 Gy to 90% isodose line (before American Association of Physicists in Medicine Task Group No. 43 formalism), whereas high-risk patients received 110 Gy to the prostate followed by EBRT of 45 Gy to the pelvis 2 months after brachytherapy.…”

Definitive Radiation Treatment Patterns and Outcomes for Low and Intermediate Risk Prostate Cancer Patients

“…5 PCa brachytherapy outcomes from a Hospital in Ghana revealed disease control rates comparable to historical controls from high volume centers. [6][7][8][9] The facility has recently begun offering EBRT with a modern linear accelerator unit. It is necessary to evaluate treatment outcomes in Co-60 era to consolidate gains made and identify potential avenues for improvement and research opportunities in this transition.…”