Radical Prostatectomy vs Brachytherapy
Dear OncoLink "Ask The Experts,"
My brother was recently diagnosed with prostate cancer, Gleason score 3+4=7. He is 60 years old and otherwise healthy and works in an occupation doing physical work. His foremost concern is making a treatment decision to ensure his long term survival. For this reason, he is leaning toward surgery. He is somewhat concerned about the side effects of the surgery. He would really prefer to have brachytherapy if he could believe his survival chances would be equal. If brachytherapy failed, what is the average length of time before recurrence, what are treatment options, outcome rates.
Thank you so very much for your reply, your help is greatly appreciated.
Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:
In general for patients with prostate cancer and Gleason score 3+4=7 tumors we have found that the success goes down with seeds while it does not particularly change with surgery or external radiation. In a young man in good health I have a bias in favor of surgery because the surgeons I work with at the University of Pennsylvania do the operation so well. With surgery in a 60 year old man, the risk of incontinence (leakage of urine) is about 3% after 2 months, and the risk of losing sexual function is about 60% with a cure rate of about 92-93%. This compares with the seeds where the risk of incontinence is about 0.1% and impotence is about 60%, but the likelihood of cure is between 60 and 70%. The other problem is that if the tumor recurs after seeds, it usually happens in 2 to 3 years, but can happen after 10 years. The only drawback to the surgery is that he does a lot of physical work, and with heavy lifting or straining the risk of urine leakage is greater, so men who opt for this route should empty their bladder before they start weight lifting. There is not a lot of good literature on this subject because there are no trials comparing the treatment.