Survival rates for men with localized prostate cancer are better with either
surgery or radioactive seed implantation, a treatment called brachytherapy,
compared with no “definitive” treatment, investigators at the University of Utah
in Salt Lake City report. This is true even among older men.

Based on the
research, reported in the journal Cancer, men undergoing surgery or
brachytherapy are much less likely to die of prostate cancer or any cause
compared with men undergoing no definitive therapy.

“This study is the
first to demonstrate an apparent overall survival advantage for brachytherapy
compared with no definitive treatment, and validates prior reports that document
a survival advantage for surgery,” Dr. Jonathan D. Tward and associates
write.

Nonetheless, only a
small number of men with localized prostate cancer will die of the disease
within 10 years, the investigators note, and both surgery and brachytherapy are
invasive procedures with possible lifetime side-effects.

“Factors other than
survival, such as risks, side effect profiles, and quality of life weigh heavily
on men deciding to undergo treatment for this disease, which is unlikely to
claim their life,” the authors comment. For those who opt for definitive
treatment, “both younger and older men should be counseled that either surgery
or brachytherapy is appropriate.”

Using the National
Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database of
60,269 men diagnosed with localized prostate cancer between 1998 and 2002, Tward
and colleagues assessed the rate of death due to prostate cancer or any cause
after a median of 46 months.

Outcomes of
brachytherapy, removal of the prostate (prostatectomy) or no definitive
treatment were assessed for men less than 60 years of age at diagnosis and those
aged 60 years and older.

Prostate
cancer-specific mortality rates at 10 years for the younger age group were 1.3
percent with surgery, 0.5 percent with brachytherapy and 3.7 percent with no
definitive therapy.

For older men, corresponding mortality rates were 3.8 percent with
surgery, 5.3 percent with brachytherapy and 8.4 percent with no definitive
therapy.

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