World Journal of Urology

, Volume 27, Issue 5, pp 607–612

Radical retropubic prostatectomy versus brachytherapy for low-risk prostatic cancer: a prospective study

  • C. Giberti
  • L. Chiono
  • Fabrizio Gallo
  • M. Schenone
  • E. Gastaldi
Original Article

Abstract

Objectives

To compare the oncological and functional outcomes reported after radical retropubic prostatectomy (RRP) versus brachytherapy (BT) in the treatment of low-risk prostatic cancer (CaP).

Methods

Between May 1999 and October 2002, 200 patients (mean age 65.3 ± 8.7) were enrolled and randomized into two groups of 100 patients each to undergo RRP (group 1) or BT (group 2).

Prior to and following treatment, all patients were evaluated by physical examination, PSA assay and compilation of IPSS, IIEF-5 and EORTC-QLQ-C30/PR25 questionnaires. Oncological results were reported at 5 years, while functional outcomes were reported at 6 months, and 1 and 5 years mean follow-up.

Results

Of the 200 patients studied, 174 completed the 5-year follow-up assessment. With regards to oncological outcomes, similar 5-year biochemical disease-free survival rates were reported for RRP (91.0%) or BT (91.7%). At 6 months and 1 year, both techniques produced a significant decrease in quality of life aspects, while group 2 patients reported a significantly higher and longer lasting rate of urinary irritative disorders and better erective function than group 1. No differences in functional outcomes were encountered after 5 years in either group.

Conclusions

RRP and BT are two different options for the treatment of low-risk CaP, which produce different short-term sequelae in terms of urinary disorders and erective functions, but similar biochemical disease-free survival. Further studies with a higher number of patients and a longer follow-up are needed to evaluate their comparative effectiveness on overall disease-specific survival and metastatic disease.

Keywords

Retropubic prostatectomy Brachytherapy Prostatic cancer Urination disorders Erectile dysfunction 

References

  1. 1.
    D’Amico AV, Whittington R, Malkowicz SB, Shultz D, Blank K, Broderick GA, Tomaszewski JE, Renshaw AA, Kaplan I, Beard CJ, Wein A (1998) Biochemical outcome after radical prostatectomy, external beam radiotherapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280:1584–1586. doi:10.1001/jama.280.11.969 Google Scholar
  2. 2.
    Stokes SH (2000) Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation. Int J Radiat Oncol Biol Phys 47:129–136. doi:10.1016/S0360-3016(99)00526-X PubMedGoogle Scholar
  3. 3.
    Kupelian PA, Potters L, Khuntia D, Ciezki JP, Reddi CA, Reuther AM, Carlson TP, Lein EA (2004) Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy > or =72 Gy, permanent seed implantation, or combined seed/external beam radiotherapy for stage T1–T2 prostate cancer. Int J Radiat Oncol Biol Phys 58:25–33. doi:10.1016/S0360-3016(03)00784-3 PubMedCrossRefGoogle Scholar
  4. 4.
    Litwin MS, Gore JL, Kwan L, Brandeis JM, Lee SP, Withers HM, Reiter RE (2007) Quality of life after surgery, external beam irradiation, or brachytherapy for early stage prostate cancer. Cancer 109:2239–2247. doi:10.1002/cncr.22676 PubMedCrossRefGoogle Scholar
  5. 5.
    Frank SJ, Pisters LL, David J, Lee AK, Bassett R, Kuban DA (2007) An assement of quality of life following radical prostatectomy, high-dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. J Urol 177:2151–2156. doi:10.1016/j.juro.2007.01.134 PubMedCrossRefGoogle Scholar
  6. 6.
    Borchers H, Kirschner-Hermanns R, Brehmer B, Tietze L, Reineke T, Pinkawa M, Eble MJ, Jakse G (2004) Permanent I-125 seed brachytherapy or radical prostatectomy: a prospective comparison considering oncological and quality of life results. BJU Int 94:805–811. doi:10.1111/j.1464-410X.2004.05037.x PubMedCrossRefGoogle Scholar
  7. 7.
    Burnett AL, Aus G, Canby-Hagino ED (2007) Erectile function outcome reporting after clinically localized prostate cancer treatment. J Urol 178:597–601. doi:10.1016/j.juro.2007.03.140 PubMedCrossRefGoogle Scholar
  8. 8.
    Thompson I, Thrasher JB, Aus G (2007) Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol 177:2106–2131. doi:10.1016/j.juro.2007.03.003 PubMedCrossRefGoogle Scholar
  9. 9.
    Nag S, Beyer D, Friedland J, Grimm P, Nath R (1999) American Brachytherapy Society reccomendations for transperineal permanent brachytherapy of prostate cancer. Int J Radiat Oncol Biol Phys 44:789–799. doi:10.1016/S0360-3016(99)00069-3 PubMedCrossRefGoogle Scholar
  10. 10.
    Barry MJ, Fowler FJ, O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, Cockett AT (1992) The American Urological Association symptom index for benign prostatic hyperplasia. J Urol 148:1549–1556PubMedGoogle Scholar
  11. 11.
    Rosen R, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A (1997) International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49:822–830. doi:10.1016/S0090-4295(97)00238-0 PubMedCrossRefGoogle Scholar
  12. 12.
    Aaronson NK, Ahmedzai S, Bergman B (1993) The European Organization for Research and Treatment of Cancer QLQC-30: a quality of life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376. doi:10.1093/jnci/85.5.365 PubMedCrossRefGoogle Scholar
  13. 13.
    Wahlgren T, Brandberg Y, Haggarth L, Hellstrom M, Nilsson S (2004) Health-related quality of life in men after treatment of localized prostate cancer with external beam radiotherapy combined with (192)ir brachytherapy: a prospective study of 93 cases using the EORTC questionnaires QLQ-C30 and QLQ-PR25. Int J Radiat Oncol Biol Phys 60:51–59. doi:10.1016/j.ijrobp.2004.02.004 PubMedGoogle Scholar
  14. 14.
    Walsh PC (1998) Anatomic radical prostatectomy: evolution of the surgical technique. J Urol 160:2418–2424. doi:10.1016/S0022-5347(01)62202-X PubMedCrossRefGoogle Scholar
  15. 15.
    Stone NN, Stock RG (1995) Brachytherapy for prostate cancer: real-time three-dimensional interactive seed implantation. Tech Urol 1:72–80PubMedGoogle Scholar
  16. 16.
    Stock RG, Stone NN, Tabert A, Iannuzzi C, DeWyngaert JK (1998) A dose response study for I-125 prostate implants. Int J Radiat Oncol Biol Phys 41:101–108. doi:10.1016/S0360-3016(98)00006-6 PubMedGoogle Scholar
  17. 17.
    Heidenreich A, Aus G, Bolla M, Joniau S, Matveev VB, Shmid HP, Zattomi F (2008) EAU guidelines on prostate cancer. Eur Urol 53:68–80. doi:10.1016/j.eururo.2007.09.002 PubMedCrossRefGoogle Scholar
  18. 18.
    Roach M, Hanks G, Thames HJ, Schellhammer P, Shipley WU, Sokol GH, Sandler H (2006) Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: reccomandations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 65:965–974. doi:10.1016/j.ijrobp.2006.04.029 PubMedGoogle Scholar
  19. 19.
    Agresti A (ed) (1990) Categorical data analysis. Wiley, New York, pp 59–66Google Scholar
  20. 20.
    Crook J, Fleshner N, Roberts C, Pond G (2008) Long-term urinary sequelae following 125iodine prostate brachytherapy. J Urol 179:141–146. doi:10.1016/j.juro.2007.08.136 PubMedCrossRefGoogle Scholar
  21. 21.
    Walsh PC, Marschke P, Ricker D, Burnett AL (2000) Patient reported urinary continence and sexual function after anatomic radical prostatectomy. Urology 55:58–61Google Scholar
  22. 22.
    Colberg JW, Decker RH, Khan AM, McKeon A, Wilson LD, Peschel RE (2007) Surgery versus implant for early prostate cancer: results from a single institution, 1992–2005. Cancer J 13:229–232Google Scholar
  23. 23.
    Buron C, Le Vu B, Cosset J, Pommier P (2007) Brachytherapy versus prostatectomy in localized prostate cancer: results of a French multicenter prospective medico-economic study. Int J Radiat Oncol Biol Phys 67:812–822. doi:10.1016/j.ijrobp.2006.10.011 PubMedGoogle Scholar
  24. 24.
    Caffo O, Fellin G, Bolner A, Coccarelli F, Divan C, Frisinghelli M, Mussari S, Ziglio F, Malossini G, Tomio L, Galligioni E (2006) Prospective evaluation of quality of life after interstitial brachytherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 66:31–37. doi:10.1016/j.ijrobp.2006.04.009 PubMedGoogle Scholar
  25. 25.
    Potters L, Torre T, Fearn PA, Leibi SA, Kattan MW (2001) Potency after permanent prostate brachytherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 50:1235–1242. doi:10.1016/S0360-3016(01)01578-4 PubMedGoogle Scholar
  26. 26.
    Burnett AL, Aus G, Canby-Hagino ED, Cookson MS, D’Amico A (2007) Erectile function outcome reporting after clinically localized prostate cancer treatment. J Urol 178:597–601. doi:10.1016/j.juro.2007.03.140 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • C. Giberti
    • 1
  • L. Chiono
    • 1
  • Fabrizio Gallo
    • 1
  • M. Schenone
    • 1
  • E. Gastaldi
    • 1
  1. 1.Division of Urology, Department of SurgerySan Paolo HospitalSavonaItaly

Personalised recommendations