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

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). Methods: 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. © Springer-Verlag 2009.