Another article shows prostate seeds results in better urinary and sexual function than Surgery (Prostatectomy)
Posted on: 04/10/2011
Prostate seeds results in better urinary and sexual function than surgery
The majority of new prostate cancer diagnoses in the US are detected at an early stage due to PSA screening. Cure rates are very high in this group when treated with brachytherapy (seeds), radical prostatectomy (surgery), or external beam radiation. Currently, there is no solid evidence on which treatment yields the best cure rates or least side effects. With this background, the American College of Surgical Oncology Group developed the Surgical Prostatectomy versus Intersitial Radiation Intervention Trial (SPIRIT). Ambitious in design, the trial intended to randomize patients to treatment with surgery or seeds. Despite availability in multiple centers across North America, the trial was closed due to poor accrual. The investigators instead focused on side effects and quality of life. To minimize bias, information was gathered through mailed questionnaires.
With follow-up of over 5 years, men treated with seeds had significantly better urinary and sexual function than those who had surgery. Overall patient satisfaction was higher in those who were treated with seeds as well. Although seeds can cause short term urinary irritation, this resolves over the long term. It also emphasizes the significant impact of urinary incontinence, a surgery related complication, upon quality of life. This study supports the previous finding that sexual function was better preserved with seeds. It also contradicts the notion that late impotency is associated with seeds. This data was presented in the February 2011 issue of the prestigious Journal of Clinical Oncology.
Patients diagnosed with early stage prostate cancer are faced with a complex treatment decision. With institutional studies showing comparable outcomes between surgery and seeds, side effects, complications, and recovery time are paramount. The decision process may have clarified with this new study showing men enjoy a more favorable quality of life with seeds over surgery.
The reference to the manuscript:
Crook, JM, et al. Comparison of Health-Related Quality of Life 5 Years After SPIRIT: Surgical Prostatectomy Versus Interstitial Radiation Invervention Trial. Journal of Clinical Oncology Vol. 29, #4, February 1, 2011.
Of note, we previously published another quality of life report (below). This study showed similar findings - brachytherapy superior to surgery, however the study below specifically investigated robotic surgery. Brachytherapy was still superior even to robotic surgery.
Malcolm, JB, et al, Quality of Life After Open or Robotic Prostatectomy, Cryoablation, or Brachytherapy for Localized Prostate Cancer. Journal of Urology, May 2010, 183(5), pg 1822-1828.
A recent publication by Malcolm et al. published in May 2010 in the Journal of Urology compared health related quality of life between patients treated with open radical prostatectomy, robotic laparoscopic prostatectomy, brachytherapy, and cryotherapy.
Assessments were completed at 3, 6, 12, 18, 24, and 30 months after treatment. 785 patients were studied.
This study showed that brachytherapy and cryotherapy had a 3 fold higher rate of return to baseline urinary function compared to either open or robotic surgery. Sexual function was highest after brachytherapy, with a 5-fold higher rate of return to baseline function compared to cryotherapy, or either type of surgery. All 4 treatments were associated with only minor rectal side effects.
More and more data has been published focusing on quality of life, and almost ubiquitously shows that brachytherapy is superior to surgery in treating prostate cancer. In addition, long term outcome data continues to be published that shows brachytherapy to have at least equivalent cure rates to surgery, and very likely superior cure rates as well. We believe this is because brachytherapy can effectively treat small amount of cancer that has spread beyond the prostate (called extra-capsular extension). Surgery cannot do this, which can lead to microscopic recurrence that can often require external beam radiation down the road.
For additional important information regarding prostate cancer and treatment, please see the Prostate Cancer Commentary (PCa) articles on this site.
For a copy of this quality of life article please click here.
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