Radical prostatectomy versus brachytherapy for early-stage prostate cancer

Background and Purpose: The considerations in choosing a treatment for pros tate cancer are potential for cure, acute toxicity, long-term morbidity, qu ality of life, and direct and indirect costs. The classic options are radic al 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 t erms of cancer control, complications, and cost using series from medical c enters 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 patient s with stage T-2c or lower disease and a Gleason score of less than or equa l to 6. In the brachytherapy series from Seattle, the 7-year success rate ( PSA less than or equal to 0.5 ng/mL) was 79%, Postoperatively, 68% of the p atients who were potent preoperatively maintained erectile function, and 92 % were fully continent. Urethral toxicity is slightly more common in patien ts treated by brachytherapy, but in the authors' series, no patient remaine d incontinent after 6 months. Some patients became impotent during follow-u p. The cost of brachytherapy ($16,200) is less than that of ($27,000), alth ough the difference may be reduced by the use of neoadjuvant hormonal thera py with the former. Conclusion: Patients receiving brachytherapy appear to have a slightly high er rate of disease progression. The side effects generally are acceptable a nd may be less severe than those of surgery. Further follow-up data are nee ded to define the roles of these two treatments for early-stage prostate ca ncer.