Radical prostatectomy versus brachytherapy for early-stage prostate cancer.
OBJECTIVE
The considerations in choosing a treatment for prostate cancer are potential for cure, acute toxicity, long-term morbidity, quality of life, and direct and indirect costs. The classic options are radical prostatectomy, external-beam radiation, and watchful waiting. During the last decade, technological advances have fostered another: brachytherapy.


METHODS
This article compares brachytherapy and radical prostatectomy in terms of cancer control, complications, and cost using series from medical centers that have pioneered and advocated particular procedures.


RESULTS
In the surgical series from Johns Hopkins, the 7-year success rate (no PSA >0.2 ng/mL) of anatomic radical prostatectomy was 97.8% in patients with stage T(2c) or lower disease and a Gleason score of < or =6. In the brachytherapy series from Seattle, the 7-year success rate (PSA < or =0.5 ng/mL) was 79%. Postoperatively, 68% of the patients who were potent preoperatively maintained erectile function, and 92% were fully continent. Urethral toxicity is slightly more common in patients treated by brachytherapy, but in the authors' series, no patient remained incontinent after 6 months. Some patients became impotent during follow-up. The cost of brachytherapy ($16,200) is less than that of ($27,000), although the difference may be reduced by the use of neoadjuvant hormonal therapy with the former.


CONCLUSIONS
Patients receiving brachytherapy appear to have a slightly higher rate of disease progression. The side effects generally are acceptable and may be less severe than those of surgery. Further follow-up data are needed to define the roles of these two treatments for early-stage prostate cancer.
Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA. malexianu@hotmail.com
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M
Alexianu
G H
GH
Weiss
D001918:Brachytherapy / Q000009:adverse effects / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000032:analysis; D011468:Prostatectomy / Q000009:adverse effects / Q000191:economics; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D011788:Quality of Life
D017430:Prostate-Specific Antigen