There has been much controversy over the past several years regarding the best treatment option for prostate cancer.  To date, there is no clear-cut data to prove the advantage of surgery over other treatment options.  Recently, there has been a new enthusiasm for IMRT (Intensity Modulated Radiation Therapy) and proton beam radiation therapy for the treatment of prostate cancer.  Again, there is no data to support that either therapy is superior to brachytherapy for the treatment of prostate cancer. However, there is data suggesting that brachytherapy is superior to IMRT.  Data from the latest Meeting of the American brachytherapy Society, presented by Michael Zelefsky, M.D. from Sloan-Kettering Cancer Center, NY (June 2009), compared 2292 patients that were treated with IMRT or brachytherapy.  Results found that the 7-year PSA relapse-free survival (PRFS) for low-risk patients was 92.4% for patients treated with brachytherapy and 91.6% for patients treated with IMRT.  However, the 7-year PRFS for intermediate-risk patients treated with brachytherapy and IMRT were 91% and 79% respectively.  There appears to be a trend to late failures with IMRT for intermediate-risk patients, thus proving the superiority of brachytherapy over IMRT.[1]  In addition, there is no data suggesting proton beam radiation therapy is better than IMRT [2].  Therefore, using the classic logic argument, if A (brachytherapy) > B (IMRT), and B = C (Proton Beam), then A > C. There will never be a randomized study of brachytherapy vs. IMRT vs. proton beam because of physician bias and patient preference.  Unfortunately, in today’s healthcare market, some physicians are making patient recommendations based on their own financial gain and not regarding the patient’s best interest. (See our blog below regarding Dr. Simone’s article “The Gullible Decade”). [3]

Aside from scientific data, there are other reasons why brachytherapy is superior to other forms of external beam radiation therapy.  A big reason is cost.  brachytherapy is a much more cost effective form of treatment.  On average, brachytherapy runs $8,000 plus the cost of the seeds.  While the cost of IMRT ranges from $35,000 – $55,000 and proton beam therapy can exceed $100,000.  One must also look at patient consideration when evaluating treatments.  brachytherapy is a 1-time (1 day, out-patient) procedure with a patient able to resume daily activities within 1-2 days.  However, both IMRT and proton beam therapy involve 30-60 min. treatments 5 times per week over 8 weeks.  Not to mention the travel time to and from the radiation facility which are usually not located right in a patient’s community.

In conclusion, there is much data out there to support brachytherapy as a superior therapy in the treatment of prostate cancer.

1.  Zelefsky MJ, Yamada Y, Kollmeier MA, et al: Comparison of tumor control outcomes and toxicity between LDR brachytherapy and high dose IMRT for clinically localized prostate cancer. brachytherapy 8:105-180,2009.

2.  Nguyen PL, Trofimov A, Zietman A:  Proton-beam vs intensity-modulated radiation therapy; Which is best for treating prostate cancer? Oncology 22:748-754, 2008.

3.  Simone JV: The gullible decade. Oncology Times  6, Jan 25, 2010.

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