Dr Eve Tiong
The new draft guidelines for PSA testing in Australia released for consultation in recent weeks are a positive step forward in the prostate cancer battle. However, for increased early detection to really pay off, access to the most effective prostate cancer treatments must be improved for men living outside the eastern states of Australia.
One of the key advantages of early detection is that men can be offered the best treatment options, including active surveillance, surgery, and radiation therapy (RT).
Approaches that are effective and have the low side effect profile (sexual function and continence, most specifically) are clearly desirable options for patients, but these rely on cancer being picked up in the early stages, giving men time to decide with all options on the table.
Prostate cancer remains the most diagnosed cancer among Australian men, with an estimated 26,368 new cases in 2024 alone — the equivalent of 72 men receiving a diagnosis and 11 deaths every day(1). Yet access to critical treatment options remains uneven across the country, with men living in rural and regional areas often missing out.
As Australia continues to improve prostate cancer outcomes, including these new screening guidelines, it is essential that equity in treatment access keeps pace. All patients should have access to the full range of medically appropriate options, regardless of their postcode.
While effective and available in some regional places, external beam radiation requires regular trips to treatment centres which results in additional burden for men, such as those in regional Western Australia, who may live a plane ride or several days drive away from their nearest hospital, sacrificing time away from work and family.
So, what are the alternatives for rural men?
Whilst stereotactic radiation therapy (also known as SABR) may be suitable for some men and can provide a shorter course of external beam treatment with fewer visits compared to traditional radiation, another highly targeted option is low-dose-rate (LDR) brachytherapy.
LDR brachytherapy irradiates only the prostate gland and avoids all healthy tissue outside the prostate, it is a highly effective treatment for localised prostate cancer(3). It involves implanting small radioactive seeds, each smaller than a grain of rice, into the prostate, delivering radiation directly to the tumour while sparing healthy surrounding tissue(3). The procedure has been used safely and successfully for decades, yet, in many Australian states and territories, patients are still unable to access it widely.
Brachytherapy is a well-established treatment for several cancers, including prostate, cervical, breast and skin cancers(3). It can be delivered as a day procedure and has been shown to offer high survival rates with minimal side effects(3-4).
Using LDR brachytherapy seeds, we can treat the affected area in a quick outpatient procedure lasting just 30–60 minutes, significantly reducing the risk of side effects like erectile dysfunction, urinary incontinence and bowel injury(3-4). Once implanted, the seeds do not need to be removed, as they naturally become inactive after a few months(4).
Despite its proven benefits, LDR brachytherapy is not equally distributed across Australian states and territories.
Our team in Perth has been working hard in the last year to re-establish LDR prostate brachytherapy in Western Australia after at least a six-year hiatus. I am passionate about ensuring every man diagnosed with prostate cancer, regardless of where he lives, is offered the full range of evidence-based treatment options.
Focal treatment is an emerging concept to treat very early, well localised prostate cancers. We now have the option of focal LDR brachytherapy which allows us to deliver radiotherapy in a very accurate manner to the identified tumour itself within the prostate.*
This method further minimises side effects, because we’re only treating a small focus area within the prostate, and it also allows room for salvage treatments if there is any relapse within the prostate down the track.
The concept of LDR brachytherapy is not new, it has been in use in Australia for almost 20 years with proven cancer control and reduced toxicity to surrounding tissue.
While focal LDR brachytherapy is an exciting advancement, in line with all focal prostate cancer treatments it is still considered experimental. Within Australia, focal LDR brachytherapy is currently offered in selected centre as part of the LIBERATE registry.
I am a strong believer that patients deserve all options available to them. Without having LDR brachytherapy available in all states and territories, patients must repeatedly travel long distances to receive external beam radiation, opt for surgery, or commit to going interstate to receive LDR brachytherapy. This is costly in terms of travel, accommodation, time away from work and family, and only adds to the burden of the disease.
With LDR brachytherapy, patients require just two day procedures in hospital; one for their volume study, which is a day procedure under general anaesthesia, followed by another visit four weeks later for implantation of the radioactive seeds into the prostate.
In our recent experience, most patients are able to go home the same day after their treatment. This is much more acceptable for men in regional and remote areas.
Research shows that when cancer treatment requires long travel or extended time off work, patients are less likely to pursue or complete treatment(5-6). In prostate cancer, this can result in men opting for less suitable treatments or delaying care altogether(5-6).
As Australia continues to improve prostate cancer outcomes, including these new screening guidelines, it is essential that equity in treatment access keeps pace. All patients should have access to the full range of medically appropriate options, regardless of their postcode.
My team and I would like to see national consistency in access to LDR brachytherapy, including increased investment in training, infrastructure and outreach to regional cancer centres.
Author:
Dr Eve Tiong is a highly experienced radiation oncologist based at Icon Cancer Centres in Midland and Rockingham, Western Australia. She also works in partnership with the team at Perth Urology Clinic and is a fellow of the Royal Australian and New Zealand College of Radiologists (FRANZCR). Dr Tiong has completed a radiation oncology fellowship specialising in urological cancers, lymphoma, gastrointestinal malignancies and sarcoma at the Princess Margaret Hospital in Toronto, Canada.
Her clinical experience covers a broad range of solid tumour malignancies, with special clinical interest in prostate cancer, lung cancer, skin cancer, breast cancer, bladder cancer, gastrointestinal cancer and lymphoma.
*Focal LDR brachytherapy is still experimental in Australia and is only available within specific centres, under trials such as the LIBERATE patient registry.
References:
1. Prostate Cancer Foundation of Australia. (2024, August 15). Prostate cancer cases surge. Access online here.
2. Cancer Australia. (2024, September 30). Prostate cancer in Australia statistics. Access online here.
3. Nag, S., & Martinez-Monge, R. (2020). Evolution of brachytherapy for prostate cancer. International Journal of Radiation Oncology, Biology, Physics, 107(2), 247–256. Access online here.
4. Cancer Council Victoria. (n.d.). Brachytherapy. Cancer Council Victoria. Retrieved March 28, 2025, from Access online here.
5. Jones, A. P., Haynes, R., Sauerzapf, V., & Crawford, S. M. (2008). Travel time to hospital and treatment for breast, colon, rectum, lung, ovary and prostate cancer. European Journal of Cancer, 44(7), 992–999. Access online here.
6. Baade, P. D., Dasgupta, P., Aitken, J. F., & Turrell, G. (2011). Distance to the closest radiotherapy facility and survival after a diagnosis of rectal cancer in Queensland. Medical Journal of Australia, 195(6), 350–354. Access online here.
