Brachytherapy vs. radical prostatectomy: Efficacy is equal, not functional effects

Chicago-Brachytherapy and radical prostatectomy are effective treatments for localized prostate cancer, but have different long-term functional effects, 13-year follow-up data show.

Patients treated with brachytherapy reported more irritative voiding symptoms, whereas radical surgery was associated with higher rates of urinary incontinence and erectile dysfunction, Elmar Heinrich, MD, of University Hospital in Mannheim, Germany, reported at the AUA annual meeting.

The findings came from a comparison of 412 prostate cancer patients treated with brachytherapy from 1991 to 2005 and 872 patients who underwent radical prostatectomy from 1995 to 2003. About 90% of the patients had clinical stage T1a-2b cancer. Follow-up averaged 4 years, but ranged to more than 13 years.

Long-term outcomes were assessed by means of a mailed questionnaire and review of patients' medical records.

"Treatment numbers for brachytherapy are increasing," said Dr. Heinrich. "For patient counseling, expected complications and side effects have to be discussed before a decision on the option of treatment is made. However, only a few reports on long-term functional outcomes for the two treatment options are available."

Patients treated with brachytherapy reported higher rates of increased voiding frequency (67.8% vs. 60.4%), nocturia (43.7% vs. 28.9%), and urgency (47.4% vs. 36.4%).

Nerve-sparing evens results

Overall, brachytherapy was associated with a lower rate of urinary incontinence (11.6% vs. 15.6%). However, the 28% of patients who had nerve-sparing radical prostatectomy had an incontinence rate of 11.2%.

Dr. Heinrich reported that 43% of brachytherapy patients had erectile dysfunction, compared with 85% among patients who had non-nerve sparing radical prostatectomy. Nerve-sparing surgery eliminated the difference between the two groups, as the frequency of erectile dysfunction was 45% in patients who had unilateral nerve-sparing surgery and 38% in patients who had bilateral nerve-sparing procedures.

Patient satisfaction was higher with brachytherapy: 96.2% of patients treated with that modality said they would recommend it as a treatment option for prostate cancer, compared with 90.2% of the patients who underwent radical prostatectomy.