AI Article Synopsis
- A retrospective review of treatment options for localized prostate cancer was conducted on 1,707 patients treated between 1992 and 2004, focusing on outcomes for brachytherapy versus radical retropubic prostatectomy (RRPP).
- Brachytherapy showed equivalent or better disease control rates compared to RRPP, particularly in intermediate and high-risk groups, where it outperformed surgery in controlling cancer recurrence as measured by PSA levels.
- The conclusion emphasized that there was no significant advantage of RRPP over brachytherapy regarding relapse time, suggesting that both treatment options should be considered for patients.
Article Abstract
Purpose: In an effort to shed light on the continuing debate over the best treatment options for patients with localized prostate cancer, we present a retrospective review of patients from a single group community urology practice.
Methods And Materials: Data from 1707 patients were reviewed. These patients, with T1 or T2 adenocarcinoma of the prostate, were treated from 1992 to 2004 with either brachytherapy or radical retropubic prostatectomy (RRPP); 81% were aged over 65 years. Patients were classified into risk groups based on initial prostate-specific antigen (PSA) and Gleason score. Time to PSA-indicated recurrence was used as the measure of disease control and cure.
Results: Time to PSA-indicated recurrence was used as a measure of efficacy. Brachytherapy with 103Pd exclusively and RRPP were found to provide equivalent control (<0.4 ng/mL for prostatectomy and <3 successive rises in PSA as defined by the American Society for Therapeutic Radiology and Oncology [ASTRO]) in low-risk groups (89% seeds vs. 94% RRPP). In intermediate (89% seeds vs. 58% RRPP) and high-risk (88% seeds vs. 43% RRPP) groups, brachytherapy patients had better control rates. The addition of external radiation, with or without luteinizing hormone-releasing hormone therapy, improved biochemical control rates in intermediate and high-risk brachytherapy groups.
Conclusion: The results failed to show any superiority of prostatectomy over brachytherapy with 103Pd (TheraSeed; Theragenics Corp., Buford, GA) regarding time until relapse as indicated by PSA level increase (>0.4 ng/mL for prostatectomy and >3 successive rises in PSA as defined by ASTRO). We recently reviewed our techniques and improved equipment from 1995 to present and found major gains with both brachytherapy and surgery. Low risk brachytherapy resulted in 99% freedom from PSA failure while surgery showed results of 97%. Brachytherapy and prostatectomy should be offered without bias to all men with stage T1 and T2 organ-confined prostate cancer.
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| http://dx.doi.org/10.1016/j.brachy.2004.12.001 | DOI Listing |
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