Nonsurgical Prostate Cancer Treatment Yields 98% Survival Rate in Younger Men

A study that evaluated 76 patients, aged 48 to 62years, who underwent prostate brachytherapy between 1995 and 1999 using eitherpalladium-103 or iodine-125 seed implants, reported that more than 98% achieved5-year survival. The study report was published in a recent issue of the International Journal of Radiation Oncology, Biology, and Physics (50:1253-1257,2001).

"This study reinforces the notion that brachytherapy is often theoptimal treatment for early-stage prostate cancer in men under 65," saidresearcher Gregory Merrick, MD, of the Schiffler Cancer Center in Wheeling, WV."These are encouraging findings because it shows younger men that they cansurvive cancer with a significantly lower incidence of side effects."Common side effects associated with prostate cancer treatment are incontinenceand erectile dysfunction.

Study Protocol

All 76 patients underwent transperineal ultrasound-guided prostatebrachytherapy; 47 patients received only brachytherapy, and 29 receivedmoderate-dose external-beam radiation followed by brachytherapy. None of thepatients received hormonal manipulation as part of their treatment.

Patients were stratified according to disease level as determined by clinicalT stage, prostate-specific antigen (PSA) level, and Gleason score. Low-riskdisease was defined as exhibiting all three favorable prognostic indicators,intermediate-risk disease as exhibiting one unfavorable indicator, and high-riskdisease as exhibiting two or more unfavorable indicators.

After treatment, patients were screened every 3 to 6 months for diseaserecurrence with digital rectal examinations and PSA tests. Among patients withlow-, medium-, and high-risk disease, 97.7%, 100%, and 100%, respectively,experienced biochemical freedom from failure 37 months after treatment. Of theentire group, 98.7% showed no evidence of disease at 37-month follow-up.

Effect of Age on Brachytherapy Outcomes

This study was the first to evaluate the effect of age on brachytherapyresults. Men diagnosed at a younger age are more likely to have an early-stagetumor that has not spread beyond the prostate gland. Therefore, younger men areoften ideal candidates for brachytherapy. However, despite the proven efficacyof brachytherapy in early-stage prostate cancer, many physicians prefer removingthe prostate gland in young, otherwise healthy men.

"Men under 60 need to be aware that there is life after prostatecancer," said Dr. Merrick. "If men detect prostate cancer at an earlystage, brachytherapy can effectively eradicate the cancer without causingincontinence and impotence." According industry data, 50% to 90% ofprostatectomy patients experience erectile dysfunction, compared to 5% to 15% ofbrachytherapy patients. The incidence of incontinence with prostatectomy is ashigh as 65%, whereas it is close to zero for brachytherapy patients.