The controversy over the best approach for treating men with a new diagnosis of Prostate Cancer continues.  It is worth noting that this debate will be difficult to settle without a head to head comparison between the treatments.  A direct comparison was attempted ten years ago but not surprisingly this failed; no prostate cancer patient was willing to have a coin-toss determine whether they underwent major surgery versus radiation therapy.

In the GU symposium sponsored by ASCO, Cieski and Colleagues analyzed a large Medicare database and identified 137,427 patients with prostate cancer.  The patients were treated between 1991 to 2007.  7.3% of patients experienced a side-effect significant enough for a subsequent procedure being done.  The breakdown of the side effects is as noted above.

Seed Implant (Brachytherapy) patients appeared to do the best with the the lowest urinary side-effects, low bowel side-effects and the lowest likelihood of requiring subsequent procedures to deal with complications.

Modern external beam radiation therapy (IMRT/IGRT) was not available until the last few years of this study period.  A different comparison has shown IMRT to be superior than the older form of external beam in terms of side effect profile.

ASCO Article