Brachytherapy versus Radical Prostatectomy in Patients with Clinically Localized Prostate Cancer, Jerrold Sharkey, MD, Alan Cantor, PhD, Zucel Solc, MD, William Huff, PhD, Stanley D. Chovnick, MD, Raymond J. Behar, MD, Ramon Perez, MD, Juan Otheguy, MD, and Richard Rabinowitz, MD. Current Urology Reports, 2002;3:250-257.

In a comparative study of 1,077 prostate cancer patients treated over a nine-year period at a Florida urology practice, 869 received brachytherapy with palladium-103 (using the TheraSeed^® device) and 208 were treated with radical prostatectomy (surgery). Brachytherapy patients had an average PSA of 7.2; surgical patients had an average PSA of 6.8. The latter were somewhat younger and at slightly higher risk than those who received brachytherapy; otherwise, demographics were similar.

Research revealed brachytherapy produced a cure rate as high as surgery for low-risk patients and better than surgery for intermediate- and high-risk patients. Freedom from cancer recurrence after seven years in the low-risk group was 95% for those implanted with seeds and 87% for those undergoing radical prostatectomy. For the intermediate-risk group, the results were 88% for those with seed implants and 66% for surgery. For high-risk patients, the results were 86% with seed implants and 0% with surgery. (Communication from author Dr. Sharkey indicates adding external beam radiotherapy to seed implants results in even better outcomes for intermediate- and high-risk patients.)

In summary, patients with unfavorable initial PSA levels and/or Gleason grades experienced better results with brachytherapy. “In fact, any differences between treatments favor brachytherapy, particularly for intermediate- and high-risk groups,” according to the researchers.

Complications also were evaluated, demonstrating a lower rate of incontinence and impotence with brachytherapy. “Overall, complications have been experienced relatively infrequently by our patients,” stated the report. The incidence of impotence following brachytherapy was estimated to be 10% to 15% (depending on preoperative potency, when this information was available). In comparison, 45% of men were estimated to be impotent following prostatectomy. These rates parallel those reported by other leading prostate cancer treatment centers. In addition, preliminary results of this continuing study indicated an estimated rate of incontinence with brachytherapy to be less than 1%. If the patient had received a prior transurethral resection of the prostate, the rate was less than 5%. Very preliminary results indicated prostatectomy produced incontinence rates of less than 1%.

“Unfortunately, when a patient with localized prostate cancer seeks information and treatment, he is confronted with the bias of the treating physician and confused by conflicting opinions among different specialists,” the report stated. “We believe that brachytherapy should be offered to patients with localized prostate cancer,” the researchers concluded. “Almost one decade of experience has convinced us that when patients are well selected, and the implant procedure is performed with meticulous attention to technique by experienced teams comprised of urologists, radiation oncologists, and radiation physicists, brachytherapy offers a cure rate as high as prostatectomy with a lower rate of complications. We use transperineal ultrasound-guided palladium-103 TheraSeed^® implants for T1 and T2 prostate cancer patients. We have found this to be a minimally invasive treatment that produces results comparable with those of radical prostatectomy and, ultimately, continued excellent quality of life for the patient.”

Principal Investigator: Jerrold Sharkey, M.D., Urology Health Center, New Port Richey, Fla.