Prostate Cancer
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Early stage disease
Review of Specific Treatments
For early stage lesions in healthy patients (T1-2, N0, M0), definitive resection, permanent source brachytherapy, high dose rate (HDR) brachytherapy, 3D conformal radiotherapy (3DCRT), intensity modulated radiotherapy (IMRT), combined radiotherapy modalities such as 3DCRT plus HDR brachytherapy, or combined androgen suppressive therapy plus radiotherapy are all accepted as reasonable therapeutic alternatives (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15).
Radical prostatectomy is the only method to date with a proven survival advantage compared with watchful waiting in early stage prostate cancer patients (2), causing many practitioners to consider it the “gold standard,” against which other treatments are compared. To complicate the analysis though, other studies have found no significant difference in disease-free survival between radical prostatectomy, high dose 3DCRT, or permanent source brachytherapy (16,17). Yet another study has proven PSA-disease free survival equivalence between HDR brachytherapy and permanent source brachytherapy (9).
In other words, a number of treatment approaches appear to have similar curative potential against localized disease, with no single modality clearly proven superior to the others.
Written by Donald B. Fuller, M.D. – Radiation Oncologist