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Palladium-103 Brachytherapy versus Radical Prostatectomy in Patients with
Clinically Localized Prostate Cancer: A 12-Year Experience from a Single Group
Practice 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. Brachytherapy,
2005;4:34-44.
| Type of Study |
Compared the effectiveness of brachytherapy with palladium-103
(using the TheraSeed® device) to surgery for the treatment of
localized prostate cancer. |
| Purpose |
To identify the best treatment options for patients with localized
prostate cancer. |
| Issues |
| • |
How effective is brachytherapy? |
| • |
How does brachytherapy compare to radical prostatectomy? |
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| Number of Patients |
1,707 |
| Type of Patients |
| • |
Average PSA in the brachytherapy group was 7.0. |
| • |
Average PSA in the surgery group was 6.5. |
| • |
All patients were classified as stage T1 or T2. |
| • |
Patients in the surgery group were somewhat younger and at slightly higher risk
than those receiving brachytherapy, otherwise demographics were similar. |
|
| Length of Time
Patients Were Followed |
The study spanned 12 years, following patients treated between
1992 and 2004. |
| Notes |
In the surgery group, a PSA level greater than 0.4 ng/mL was
considered a recurrence. For the brachytherapy group, more than three
successive rises in PSA -- as defined by the American Society for Therapeutic
Radiology and Oncology -- was considered a recurrence. |
| Results and/or
Conclusions |
| • |
Brachytherapy produced a biochemical control rate better than or equal to
surgery. |
| • |
Intermediate- and high-risk patients have better outcomes with brachytherapy
than they do with surgery. |
| • |
High-risk patients treated with brachytherapy demonstrated an 88% biochemical
control rate, compared to 43% with surgery. |
| • |
Intermediate-risk patients treated with seeding experienced a biochemical
control rate of 89%, compared to 58% with surgery. |
| • |
Based on 10-year data, low-risk patients receiving brachytherapy had a 99%
success rate, versus 97% with surgery. |
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* Biochemical control of the PSA to nearly undetectable levels
This retrospective study compared long-term outcomes of patients treated with
brachytherapy or radical prostatectomy at a Florida urology practice. Of 1,707
prostate cancer patients treated during a 12-year period from 1992 to 2004,
1,380 received brachytherapy with palladium-103 (using the TheraSeed®
device) and 281 had surgery (data on remaining patients was insufficient for
inclusion in the study). Brachytherapy patients had an average PSA of 7.0;
surgical patients had an average PSA of 6.5. The latter were somewhat younger
and at slightly higher risk than those who received brachytherapy; otherwise,
demographics were similar.
Key findings of the study reveal that high- and intermediate-risk prostate
cancer patients treated with brachytherapy using palladium-103 experienced
greater success than patients treated with prostatectomy.
| • |
High-risk patients receiving brachytherapy had an 88% biochemical control rate, compared to 43% with surgery. |
| • |
Intermediate-risk patients treated with brachytherapy experienced a biochemical control rate of 89%, compared to 58% with surgery. |
| • |
Based on 10-year data, low-risk patients had a 99% success rate, versus 97% who had surgery. |
Overall, patients experienced relatively infrequent complications. Rates of incontinence with brachytherapy and surgery were less than 1%. For brachytherapy patients with a prior transurethral resection of the prostate, the rate was less than 5%. The study revealed more pronounced differences regarding impotence. With brachytherapy, the incidence of impotence over time is estimated to be 10-15% (depending on preoperative potency, when this information was available from patient records) versus 45% for surgery.
“Because we perform both procedures (brachytherapy and surgery), we are in a unique position to evaluate and compare the efficacy of these two approaches,” the authors stated. “Over 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 an experienced team comprised of a urologist, radiation oncologist, and radiation physicists, brachytherapy offers a cure rate as high as prostatectomy with a lower rate of complications… Any differences between treatments favor brachytherapy, particularly for intermediate and high-risk groups.”
Principal Investigator: Jerrold Sharkey, M.D., Urology Health Center, New Port Richey, Fla.
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