Prostate news article, November 2004
| COMPARING BRACHYTHERAPY
AND RADICAL PERINEAL PROSTATECTOMY FOR ORGAN CONFINED PROSTATE CANCER Mr J. M. Bhardwa MBChB, MRCS
|
Brachytherapy is when radioactive seeds are implanted into the prostate gland and the radioactivity emanating from them destroy the cancer cells. Radical Perineal Prostatectomy is a major surgical procedure whereby the entire prostate gland is removed by an incision in the perineum (the saddle area).
H Borchers et al ( BJU International 94(6); 805-811: October 2004.) compare the above two methods. Strict criteria were used before patients could be considered for Brachytherapy or Radical Perineal Prostatectomy these included early prostate cancer with a low PSA and low grade of tumour and tumour which was confined to only on side of the prostate on biopsy of the prostate gland.
The rate of relapse as measured by a consistent rise in the PSA levels after an average follow up of 27 months was 2% after surgery and 11% after brachytherapy (Long term data is not yet available). The urinary incontinence rates were similar at 11-13% for both treatments; however faecal soilage was twice as high in patients who had received brachytherapy.
Brachytherapy was better at preserving sexual function than Radical Perineal Prostatectomy even though nerve sparing techniques were used.
The obvious draw back with Brachytherapy is that no specimen can be obtained and therefore accurate staging is not possible. 18% of patients that had Radical Perineal Prostatectomy had tumours that had spread beyond the confines of the prostate gland, while 63% of patients who underwent Radical Perineal Prostatectomy had a tumour that had actually spread to both sides of the prostate gland, thereby confounding pre-operative information of the patients' prostatic carcinoma. This data is obviously not available in the patients who underwent Brachytherapy, which is a source of concern for many patients and clinicians. More accurate ways of staging (establishing the extent of the cancer) in these patients are therefore needed as well as long term data comparing these two treatment methods.