Prostate Cancer Treatment LDR Brachytherapy Faces Decline in New Zealand

A highly effective and minimally invasive treatment for prostate cancer is becoming increasingly rare in New Zealand, according to a Tauranga urologist. Low dose-rate (LDR) brachytherapy, once widely available, is now only offered in a handful of private hospitals, raising concerns about access and availability for patients.

Dr. Mark Fraundorfer, a Tauranga urologist and one of the few practitioners still offering LDR brachytherapy, said the treatment should be available in the public health system. He noted that the procedure was once common in Auckland and Wellington but is now limited to Tauranga and Christchurch.

"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," said Fraundorfer, who is nearing retirement. "It’s not the treatment that’s the problem. It’s getting someone to be upskilled to deliver it."

LDR brachytherapy involves the implantation of tiny radioactive seeds into or near the prostate gland, delivering targeted radiation directly to cancer cells. This method minimizes damage to surrounding healthy tissue and is considered a highly effective option for men with low or intermediate risk prostate cancer.

According to Health New Zealand, around 4,260 men are diagnosed with prostate cancer each year. Fraundorfer emphasized that the treatment, which costs approximately $35,000, is a viable option but requires close collaboration between several specialist groups, including radiation therapists, oncologists, medical physicists, and anaesthetists. This complexity, he said, has contributed to its decline.

"It’s a very powerful reason for something to disappear," Fraundorfer said. "There’s no reason why it shouldn’t be a publicly offered treatment." He described the procedure as minimally invasive, with patients often returning to work within days and experiencing minimal side effects.

Mount Maunganui cancer survivor Phil Rouse, who had LDR brachytherapy over 20 years ago, said the treatment worked well for him and allowed him to maintain an active life. "It’s certainly worked for me and it’s working for others, so my doctor tells me," he said.

Prostate Cancer Foundation chief executive Peter Dickens highlighted that New Zealand men have significantly fewer treatment options compared to those in Australia or the UK. "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," Dickens said.

Health NZ Te Whatu Ora acting chief clinical officer Nadine Grey noted that while LDR brachytherapy has been reviewed as a national treatment option, its sustainability was not deemed viable due to factors such as cost and the need for a specialized workforce. She emphasized that the focus remains on delivering timely, high-quality cancer care, with the National Cancer Clinical Network working to identify optimal care pathways.

Fraundorfer is encouraging a colleague to continue the practice in Tauranga, stating, "I don’t think we should lose it as an option." As the demand for prostate cancer treatments grows, the future of LDR brachytherapy in New Zealand remains uncertain.