Brachytherapy versus radical prostatectomy in patients with clinically localized prostate cancer

Abstract

In an effort to help physicians offer their patients unbiased advice on the best alternatives for treatment of localized prostate cancer, we present a retrospective comparison of the effectiveness of brachytherapy and radical retropubic prostatectomy in 1305 men with stage T1 and T2 adenocarcinoma of the prostate. Data from 1305 patients treated in our community-based private practice urology group from 1993 to 2002 were reviewed, and patients were classified by initial prostate-specific antigen (PSA) level and risk grouping. Risk grouping was defined by preoperative PSA levels and Gleason scores. We used time to PSA-indicated recurrence as the measure of efficacy. Brachytherapy and radical prostatectomy provided similar responses to treatment (no significant differences given the sample size, length of follow-up, and numerical differences observed) for localized prostate cancers. A prospective study is presently underway to evaluate the respective outcome of these procedures (including incidence of incontinence and impotence), and assess their impact on patient quality of life. The results presented here fail to show any superiority of prostatectomy over brachytherapy with palladium-103 (TheraSeed; Theregenics Corp., Buford, GA) with respect to time until relapse indicated by PSA level increase (> 0.2 ng/mL for prostatectomy and >1.5 ng/mL and rising for brachytherapy). In fact, any differences between treatments favor brachytherapy, particularly for intermediate- and high-risk groups. We conclude that both brachytherapy and prostatectomy should be offered, equally and without bias, to men with stage T1 or T2 organ-confined prostate cancer.

Survival of men with clinically localized prostate cancer treated with prostatectomy, brachytherapy, or no definitive treatment

“…[15][16][17][18] In most, surrogate endpoints for disease progression are used based on various interpretations of PSA failure, PSA velocity, or time to PSA progression. [19][20][21][22][23][24] Nevertheless, the role of posttherapy PSA monitoring and its impact on clinical outcome remains controversial.…”

Iodine seed prostate brachytherapy: an alternative first-line choice for early prostate cancer

“…A further retrospective comparison of 1305 patients treated for stage T1-2 prostate cancer by either radical prostatectomy or brachytherapy failed to demonstrate any clear superiority of one treatment over the other. 35 Kupelian reveals similar data from a large cohort of 2991 patients treated with either brachytherapy with or without external beam radiotherapy, conformal beam radiotherapy to 472 or 72 Gy and radical prostatectomy. External beam radiotherapy given to o72 Gy appeared less effective than the other modalities, all of which appeared indistinguishable assessed at 5 y by biochemical-free survival.…”

Review on the effectiveness of prostate cancer brachytherapy

“…Tačiau, esant vidutinei (stadija ≤T2b, Gleason 7, PSA 10-20 ng/ml) ar blogai (stadija >T2b, Gleason 8-9, PSA >20 ng/ml) prognozei, išgyvenamu-mo be PSA atkryčio rezultatai po brachiterapijos buvo blogesni, lyginant su radikalia prostatektomija ar nuotoline spinduline terapija (4). Šių dviejų tyrimų duomenų nepatvirtino naujesnių tyrimų duomenys, kurių metu aptikta, kad po brachiterapijos, nuotolinės spindulinės terapijos ar radikalios prostatektomijos išgy-venamumo be PSA atkryčio rezultatai nesiskiria ne tik geros, bet vidutinės ir blogos prognozės navikų atvejais (5). P. A. Kupellian ir kt.…”

“…Pirmasis 152 pacientų 10 metų stebėsenos tyrimas nustatė 66 proc. 10 metų išgyvenamumą be PSA atkryčio (5). Šie rezultatai buvo panašūs ir po 12 metų (7).…”