Tauranga urologist Dr Mark Fraundorfer says there is "no reason" why low dose-rate brachytherapy should not be offered in the public health system. Photo / Megan Wilson
A highly effective and “minimally invasive” prostate cancer treatment is “disappearing” from private hospitals in New Zealand, a Tauranga urologist says.
Dr Mark Fraundorfer told the Bay of Plenty Times low dose-rate (LDR) brachytherapy was now only offered in Tauranga and Christchurch after being “much more widely available” 15 years ago, including Auckland and Wellington.
Fraundorfer, who is the only urologist doing the procedure at Tauranga’s Grace Hospital and nearing retirement, said it would be “disappointing” to lose it.
“It’s good to keep options available. Everyone has a different set of circumstances and losing an entire treatment modality would be a sad loss, really, because it’s not the treatment that’s the problem. It’s getting someone to be upskilled to deliver it.”
About 4260 men are diagnosed with prostate cancer annually, Health New Zealand said.
LDR brachytherapy delivered highly targeted radiation directly to prostate cancer cells, minimising damage to surrounding healthy tissue.
Tiny radioactive seeds, each smaller than a grain of rice, were implanted into or near the prostate gland. The seeds emitted radiation over a short distance, enabling precise treatment of cancerous cells while sparing healthy tissue.
Fraundorfer said the treatment was only available privately in New Zealand – “a very powerful reason for something to disappear”.
“There’s no reason why it shouldn’t be a publicly offered treatment.”
Fraundorfer said it was “very” effective, well established and safe for men with “low or intermediate risk” cancers. The average cost was $35,000.
He thought the main reason it was disappearing was because it required close co-operation between two specialist groups.
Fraundorfer said he needed a radiation therapist, a radiation oncologist, a medical physicist and an anaesthetist.
Fraundorfer said his team had been doing LDR brachytherapy in Tauranga since 1999, but it was difficult to form new teams to do it.
He said it was a “minimally invasive”, one-day procedure and the patient could return to work “within days”.
The risk of incontinence was “close to zero” and it had the lowest complication rate for long-term sexual dysfunction, he said.
Fraundorfer said patients who had prostatectomy surgery could take “weeks” off work and up to a year to regain continence. Radiation also had risks of affecting the bowel and sexual function.
He said LDR brachytherapy’s one disadvantage was the difficulty of doing surgery afterwards if the treatment failed.
However, “if it fails, it fails many years down the track”.
Fraundorfer said he planned to encourage a colleague to “take it on” in Tauranga.
“I don’t think we should lose it as an option ... ”
Mount Maunganui cancer survivor Phil Rouse had successful LDR brachytherapy “at least” 20 years ago in Tauranga.
The 87-year-old said he had no side effects, and it had allowed him to live a “normal” and active life.
Rouse said he would be concerned if it was no longer available in New Zealand.
“It’s certainly worked for me and it’s working for others, so my doctor tells me.”
Prostate Cancer Foundation chief executive Peter Dickens said men in New Zealand had “significantly fewer” treatment options than those in Australia or the UK, impacting quality of life and life expectancy.
Australia offered LDR brachytherapy publicly and privately.
Dickens said in his view, prostate cancer treatment “has not been a Government priority” within the public health system.
“We’re expecting the number of prostate cancer diagnoses to double in the next 15 years, so it’s critical that the Government takes steps now to improve access.
“That means increasing the availability of different types of treatment and ensuring they are accessible to as many men as possible.”
Health NZ Te Whatu Ora acting chief clinical officer Nadine Grey said prostate cancer had a high survival rate, with 92% survival after five years.
Rates of death had decreased in the past five years.
Treatment options included radiation therapy, chemotherapy, surgery, hormone therapy, cryosurgery, immunotherapy and “active surveillance” – monitoring “low-risk localised” prostate cancer for growth.
Grey said LDR brachytherapy had been reviewed previously as a national treatment option but the need for it was “not deemed to be sustainable”.
This would have been based on cost, patient numbers required to establish and maintain a specialist radiation workforce, and theatre and urologist capacity, Grey said.
If it was to be considered again, further review would be needed to understand the potential number of people who would benefit, costs, capacity, the model of care and cost effectiveness to deliver it safely, she said.
Grey said the delivery of timely, high-quality and safe cancer care remained a priority.
The National Cancer Clinical Network was working to identify areas of prioritisation to deliver “optimal” care pathways for the New Zealand population based on international guidelines.
Megan Wilson is a health and general news reporter for the Bay of Plenty Times and Rotorua Daily Post. She has been a journalist since 2021.