Comparing Radical Prostatectomy with Brachytherapy

Richard Whittington, MD
Last Modified: September 15, 2002

Dear OncoLink "Ask The Experts,"

I have recently been diagnosed with prostate cancer. I have a T1C tumor, discovered during a biopsy. Malignancy is found only in the left lobe, where 30% of tissue sampled is malignant. Gleason score is 7. I am 59 years of age, and otherwise in good health. My urologist is recommending radical prostatectomy. My radiation oncologist believes I am a good candidate for brachytherapy, with 3 months of hormone treatment prior to and after the procedure. I am told that the incidence of impotence is considerably lower with Brachytherapy. QUESTION: Can you provide information about 5, 10 or 15-year rates of recurrence, comparing RP with Brachytherapy? If impotence rates are less important to me than pure survival, is RP the preferred treatment? Thank you for considering my question!

Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:

First off, the ten-year survival is the same, although the risk of recurrence is higher in men undergoing implant than it is in men treated with surgery. The difference is about 70% for seeds vs. 85% for surgery. The other issue is the risk of side effects. Age is a very important factor as the younger the patient the better they will tolerate the surgery and side effects. At the University of Pennsylvania we generally recommend surgery for men less then 60 years of age because the risk of impotence with surgery is 40-45% and is 50% with seeds. The risk of incontinence with the surgery is about 2% vs. the 3% risk of rectal ulcer with seeds. A physician doing fewer than 50 implants/yr or 100 radical prostatectomies/yr may not be busy enough to be adept at the procedure and their complication rates are not as well defined. The advantage of the surgery is that you can go back and radiate the prostate bed if the PSA goes up, but you don't get a second chance after implant.