Three treatments compared

In the other study, Dr. Ciezki’s team used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify patients aged 65 years and older treated for PCa from 1991 to 2007. Of 137,427 patients identified, 60,806 (44.2%) received EBRT, 59,559 (43.3%) underwent RP, and 17,062 (12.4%) were treated with brachytherapy.

GI toxicity occurred in 1.7%, 0.1%, and 0.3% of patients treated with EBRT, RP, and brachytherapy, respectively, after a median follow-up of 71 months. Genitourinary toxicity occurred in 7.1%, 6.7%, and 3.4% of these groups, respectively.

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Within treatment modalities, the percentages receiving toxicity-related intervention were 8.8% for EBRT, 6.9% for RP, and 3.7% for brachytherapy.

The average cost per patient per year was $2,557 for brachytherapy, $6,412 for EBRT, and $3,205 for open prostatectomy, investigators found.

Prostate cancer specialist Leonard G. Gomella, MD, who headed the symposium’s program committee, noted that “many times, there’s an assumption that the newest or perhaps the most expensive modalities that we have to offer are the best for our patients. These two studies suggest from a side effect standpoint that the more expensive technologies, be they proton therapy or external beam radiation therapy, may in fact be associated with a higher risk of side effects.”

Treat patients as individuals

Dr. Gomella, who is Chair of the Department of Urology at Thomas Jefferson University’s Kimmel Cancer Center in Philadelphia, stressed that “at the end of the day we really need to look at each patient as an individual and pick for that individual patient what may be the best for them looking at both cancer control and quality of life.”

Although brachytherapy turned out to be the lowest cost option in the study by Dr. Ciezki and colleagues, men who might choose this treatment may not be a good candidate for it, Dr. Gomella observed. For example, brachytherapy probably is not good for men who have a lot of urinary symptoms. “If they choose brachytherapy, those symptoms may actually get much worse. So we have to be very careful in that we can’t paint a broad brush stroke here on all of the competing treatment options for prostate cancer.”

With respect to the higher rate of ED with IMRT, Dr. Gomella noted that this complication is the most challenging of the adverse effects in PCa management. “In spite of our efforts to do careful surgery, in spite of our best efforts to do very precise radiation, erectile function can be harmed by any of these technologies. I think it’s a little bit premature to definitively state that one technique or the other is clearly a winner when it comes to erectile dysfunction.”