Comparative Effectiveness of Prostate Cancer Treatments

A statistical analysis suggests that brachytherapy provides superior outcomes in patients with low-risk disease and intermediate-risk disease.

Comparative Analysis of Prostate-Specific Antigen Free Survival Outcomes for Patients with Low, Intermediate and High-Risk Prostate Cancer Treatment by Radical Therapy, Prostate Cancer Results Study Group: Peter Grimm, Ignace Billiet, David Bostwick, Adam P. Dicker, Steven Frank, Jos Immerzeel, Mira Keyes, Patrick Kupelian, W. Robert Lee, Stefan Machtens, Jyoti Mayadev, Brian J. Moran, Gregory Merrick, Jeremy Millar, Mack Roach, Richard Stock, Katsuto Shinohara, Mark Scholz, Ed Weber, Anthony Zietman, Michael Zelefsky, Jason Wong, Stacy Wentworth, Robyn Vera and Stephen Langley. British Journal of Urology, 2012; 109, Supplement 1; 22-29

Type of Study
Literature Review: First large scale comprehensive review of literature comparing risk stratified patients by treatment option and with long-term follow-up.

Purpose
To assess the comparative effectiveness of prostate cancer treatments using current peer reviewed publications results as a basis.

Issues  
How effective is brachytherapy when compared to other accepted forms of treatment?

How effective is brachytherapy in low-risk, intermediate-risk and high-risk patients?

Number of Patients  
Varies by study; 52, 087 patients overall

Type of Patients  
Varies by study.

Length of Time 

Varies by study; literature published between 2000 and 2010 Patients Were Followed

Results and/or Conclusions
“The findings of the study suggest that in terms of biochemical (PSA) free progression, brachytherapy approaches provide superior outcome in patients with low-risk disease.”

In low-risk patients, higher average PSA progression-free survival was reported for brachytherapy than for surgery or external beam radiation. Limited reporting available for other therapies.

In intermediate-risk patients, higher average progression-free survival was reported for brachytherapy approaches than for surgery or external beam radiation.

In high-risk patients, combination regimens of hormone therapy, brachytherapy and external beam radiation achieved higher progression-free survival than surgery, external beam or brachytherapy alone.

In a review of literature published between 2000 and 2010, the authors compared progression-free survival for radical prostatectomy, brachytherapy, external beam radiation therapy, high dose radiation, cryotherapy, robotic surgery and brachytherapy. “This study should provide cancer control information to physicians and patients attempting to make an ultimate treatment decision.” The report states, “Since it is unlikely that large randomized studies will be conducted, physicians and patients will rely largely upon the use of retrospective studies to compare treatment results.”