It seemed that it would be worthwhile to look into the robotic-assisted procedure.
Then I looked at the literature on brachytherapy.
Here’s a Japanese study. And the conclusion is that brachytherapy combined with external beam radiotherapy is as effective as prostatectomy. But notice that there is only a 4 year follow up.
This is not really long enough to give that much reassurance about recurrence.
Four year clinical statistics of iridium-192 high dose rate brachytherapy.
Shigehara K, Mizokami A, Komatsu K, Koshida K, Namiki M
Department of Urology, Kanazawa University Hospital, Kanazawa City, Japan.
Int J Urol 2006 Feb;13(2):116-21
BACKGROUND: We evaluated the efficacy and complications of high dose rate (HDR) brachytherapy using iridium-192 (192Ir) combined with external beam radiotherapy (EBRT) in patients with prostate cancer. METHODS: Ninety-seven patients underwent 192Ir HDR brachytherapy combined with EBRT at our institution between February 1999 and December 2003. Of these, 84 patients were analysed in the present study. 192Ir was delivered three times over a period of 2 days, 6 Gy per time, for a total dose of 18 Gy. Interstitial application was followed by EBRT at a dose of 44 Gy. Progression was defined as three consecutive prostate-specific antigen (PSA) rises after a nadir according to the American Society for Therapeutic Radiology and Oncology criteria. The results were classified into those for all patients and for patients who did not undergo adjuvant hormone therapy. RESULTS: The 4-year overall survival of all patients, the nonadjuvant hormone therapy group (NAHT) and the adjuvant hormone therapy group (AHT) was 87.2%, 100%, and 70.1%, respectively. The PSA progression-free survival rate of all patients, NAHT, and AHT was 82.6%, 92.0%, and 66.6%, respectively. Of all patients, the 4-year PSA progression-free survival rates of PSA<20 and PSA>or=20 groups were 100%, and 46.8%, respectively. According to the T stage classification, PSA progression-free survival rates of T1c, T2, T3, and T4 were 100%, 82.8%, 100%, and 12.1%, respectively. Prostate-specific antigen progression-free survival rates of groups with Gleason scores (GS)<7 and GS>or=7 were 92.8% and 60.1%, respectively. Of NAHT, PSA progression-free survival of PSA<20 was 100% vs 46.8% for PSA>or=20, that of T1c was 100% vs 75% for T2, and that of GS<7 was 100% vs 75% for GS>or=7. No significant intraoperative or postoperative complications requiring urgent treatment occurred except cerebellum infarction. CONCLUSIONS: 192Ir HDR brachytherapy combined with EBRT was as effective as radical prostatectomy and had few associated complications.
Here’s an article with a longer period of follow up – 12 years.
Note that the issue of whether or not the treatment is considered to have cured the patient is dealt with by observing for a rise in the PSA post treatment. In this study if we look at the results for low risk patients the control rate was 89% for brachytherapy versus 94% for surgery.
But notice at the end of the article that the authors state:
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.
103Pd brachytherapy versus radical prostatectomy in patients with clinically localized prostate cancer: a 12-year experience from a single group practice.
Sharkey J, Cantor A, Solc Z, Huff W, Chovnick SD, Behar
RJ, Perez R, Otheguy J, Rabinowitz R.
Brachytherapy. 2005;4(1):34-44
Urology Health Center, New Port Richey, FL 34652, USA. urologyhealth@yahoo.com
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.
Here’s a study from Duke University actually comparing surgery versus brachytherapy. And one of the conclusions:
“The data indicate that for low-risk disease, both treatments are effective, controlling disease in over 80% of the cases, with no evidence to support the use of one treatment over the other.”
Comparing radical prostatectomy and brachytherapy for localized prostate cancer.
Quaranta BP, marks LB, Anscher MS
Oncology (Williston Park). 2004 Nov;18(13):1582, 1585.
Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710, USA. quaranta@radonc.duke.edu
Radical prostatectomy and ultrasound-guided transperineal brachytherapy are both commonly used for the treatment of localized prostate cancer. No randomized trials are available to compare these modalities. Therefore, the physician must rely on institutional reports of results to determine which therapy is most effective. While some investigators have concluded that both therapies are effective, others have concluded that radical prostatectomy should remain the gold standard for the treatment of this disease. This article reviews the major series available for both treatments and discusses the major controversies involved in making these comparisons. The data indicate that for low-risk disease, both treatments are effective, controlling disease in over 80% of the cases, with no evidence to support the use of one treatment over the other. Similarly, for intermediate-risk disease, the conclusion that one treatment is superior to the other cannot be drawn. Brachytherapy should be performed in conjunction with external-beam radiation therapy in this group of patients. For patients with high-risk disease, neither treatment consistently achieves biochemical control rates above 50%. Although radical prostatectomy and/or brachytherapy may play a role in the care of high-risk patients in the future, external-beam radiation therapy in combination with androgen deprivation has the best track record to date.
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