BRACHYTHERAPY COMPARISON TO SURGERY AND EBRT

Patients with the best profile for a good surgical outcome also are the best candidates for brachytherapy.

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?
Number of Patients Not applicable.
Type of Patients Varies by study.
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.”

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.