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Surgery, Brachytherapy, and External-Beam Radiotherapy for Early Prostate Cancer, Richard E. Peschel, PhD, and John W. Colberg, MD. The Lancet Oncology, 2003;4(4):233-241.
| Type of Study |
Literature review. |
| Purpose |
To compare outcomes for radical prostatectomy and permanent seed implant (brachytherapy), 3DCRT and IMRT. |
| Issues |
| • |
How effective is brachytherapy? |
| • |
How does brachytherapy compare to other prostate cancer treatments? |
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| Number of Patients |
Not applicable.
|
| Type of Patients |
Varies by study.
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| Length of Time
Patients Were Followed |
Varies by study. |
| Results and/or
Conclusions |
| • |
“For patients with clinical stage T1c or T2 disease and a Gleason score of less than 8, 5-year biochemical disease-free survival is remarkably similar for all the above treatments.” |
| • |
“The best candidates for radical prostatectomy are also the best candidates for implant therapy.” |
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In a review of published literature, the authors compared outcomes for radical prostatectomy, brachytherapy, 3DCRT (three-dimensional conformal radiotherapy) and IMRT (intensity modulated external-beam radiotherapy). “For patients and their primary-care physicians,” the report stated, “the decision about which of these local modalities will offer optimum treatment can be challenging.” Data format is not uniform, definitions of biochemical disease-free survival vary, and “there is little or no relation between biochemical disease-free survival and cause-specific or overall survival.” Finally, no prospective randomized clinical trials have directly compared these forms of treatment.
The report makes the following observations about brachytherapy:
| • |
Brachytherapy is widely used in the U.S. for many reasons, including “low cost, ease of therapy, short recovery time, low morbidity, and excellent short-term biochemical disease-free survival.” |
| • |
“…implants are an excellent approach for patients in the favourable group with Gleason scores less than 7.” |
| • |
“The best candidates for radical prostatectomy are also the best candidates for implant therapy.” |
| • |
A low rate of major complications is “an attractive feature” of implant therapy. “All patients experience some degree of temporary irritative or obstructive urinary symptoms for 2-6 months after implant therapy, and about 10% develop acute urinary retention. Patients treated with I-125 have a longer duration of obstructive symptoms than those treated with Pd-10339.” |
[39] Wallner K, Merrick G, True L. et al. 1-125 versus Pd-103 for low-risk prostate cancer: morbidity outcomes from a prospective randomized multicenter trial. Cancer 2002; 8:67-73.
Principal Investigator: Richard E. Peschel, M.D., Yale University School of Medicine, New Haven, Conn.
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