Is brachytherapy comparable with radical prostatectomy and external-beam radiation for clinically localized prostate cancer?

PURPOSE

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.

MATERIALS AND 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.