Is brachytherapy comparable with radical prostatectomy and external-beam radiation for clinically localized prostate cancer?
OBJECTIVE
The aim of this study was to summarize the prostate brachytherapy literature and provide a comparative analysis of brachytherapy, radical prostatectomy, and external-beam radiation therapy outcomes for early-stage carcinoma of the prostate gland.


METHODS
Published literature on brachytherapy, radical prostatectomy, and external-beam radiation therapy for clinically localized carcinoma ofthe prostate gland was reviewed. In addition, MEDLINE searches were performed to ensure completeness of the knowledge base.


RESULTS
For patients with low-risk features, the biochemical results of prostate brachytherapy are as favorable as the most positive radical prostatectomy and external-beam radiation therapy series. In most studies, patients with intermediate- and high-risk disease have more durable biochemical outcomes when treated with brachytherapy (with or without external-beam radiation therapy). Long-term urinary morbidity is primarily restricted to patients with a history of transurethral resection. Significant bowel dysfunction is uncommon. Although erectile dysfunction occurs in approximately 50% of patients at 5 years, 80% respond favorably to sildenafil. Multiple postoperative dosimetric studies supported the ability of brachytherapists to adequately encompass the target volume. Compared with radical prostatectomy and external-beam radiation therapy, the total cost of prostate brachytherapy is 20% less.


CONCLUSIONS
With prostate-specific antigen-based follow-up as long as 10 years, the results of prostate brachytherapy for low-risk patients are as favorable as the most positive radical prostatectomy and external-beam radiation therapy series. In most reports, intermediate- and high-risk patients have more durable biochemical outcomes when managed by brachytherapy approach (with or without external-beam radiation therapy). Serious complications following brachytherapy are relatively rare.
Merrick
G S
GS
Schiffler Cancer Center, Wheeling Hospital, West Virginia 26033-6300, USA.
Butler
W M
WM
Lief
J H
JH
Dorsey
A T
AT
D001918:Brachytherapy / Q000009:adverse effects; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery*
D017430:Prostate-Specific Antigen