Written - Provision of Low Dose Brachytherapy Service in Wales for Treatment of Localised Prostate Cancer

Although there are a number of less common treatments for localised prostate cancer, the main options currently are:

• Radical prostatectomy
• External wide beam radiotherapy
• Brachytherapy
• Watchful waiting

Low dose rate (LDR) brachytherapy is a form of radiotherapy involving the insertion of between 60 and 120 radioactive seeds into the prostate under ultrasound guidance.  

It has advantages over surgery of being less invasive, and can be performed as a day case procedure in a single session under either general or spinal anaesthesia.   In comparison to external beam radiotherapy, it is much quicker and can deliver a far higher dose of radiation to prostate with far greater precision than with external beam radiotherapy. The evidence to date suggests that it is a safe and effective procedure with outcomes (in terms of mortality, morbidity and side effects) which are comparable, but no better than, the alternative treatments.

Brachytherapy is designated a specialist service and falls within the commissioning responsibility of Health Commission Wales. Health Commission Wales carried out a review of this treatment during 2006 and in June confirmed that it would commission this service for patients in Wales and would work with Velindre NHS Trust to develop a service based in Wales. In August 2006, however, in the light of increased costs for this treatment from centres in England and other competing pressures and priorities, Health Commission Wales decided it would only fund this treatment for those patients whose treatment had been suspended pending the review and under exceptional circumstances. The other treatment options of radical prostatectomy and wide beam radiotherapy fall within the commissioning remit of the Local Health Boards. However, Health Commission Wales continued to have discussions with stakeholders on providing this service in 2007-2008.

Wales Based Service

As a result of these discussions, it has been agreed that Health Commission Wales will commission Welsh low dose brachytherapy services for localised prostate cancer from Velindre NHS Trust.  This will ensure that Welsh patients with localised prostate cancer have access to this form of treatment as well as the two other forms of effective treatment for this condition, wide beam radiotherapy and surgery.

A letter of intent, offering revenue funding to Velindre NHS Trust for this purpose has been issued. I have asked that the service is established as quickly as possible.  Once start-up arrangements are in place the service will be available before the end of the summer.

Our intention is that Velindre will offer an all-Wales service. Brachytherapy can be provided on an out-patient basis, with assessment and follow-up care provided in the patient’s own locality. Recent changes to Assembly Government rules mean that travelling expenses can be claimed for cancer treatment.

Patients from North Wales will be assessed by their home clinician and referral for treatment can be made either to Velindre or an alternative provider.

Funding for the new service will be made available from the start of the financial year 2007/08. Health Commission Wales will review, individually, those patients whose need for treatment occurs before the Velindre service is available and commission accordingly. In the meantime, no patient will be without treatment for their cancer as the other two forms of effective treatment, wide beam radiotherapy and surgery, are available.