Study Compares 3 Common Prostate Cancer
TUESDAY, Jan. 31 (HealthDay News) -- Experts comparing three
leading prostate cancer therapies find external beam radiation
therapy to be more toxic and expensive than either surgery or a
more localized form of radiation therapy known as
The findings were to be presented Tuesday at a meeting in San
Francisco, hosted in part by the American Society of Clinical
Oncology (ASCO) and focused on prostate cancer.
"Research to date has not given us a clear picture of how each prostate cancer therapy affects men over the long run," study lead author Dr. Jay Ciezki, a staff physician at the Cleveland Clinic, said in an ASCO news release. "Our analysis is one of the first to examine the quality of life and financial costs of these three very common prostate cancer treatment strategies for more than five years after treatment.
In conducting the study, researchers examined treatment outcomes
among more than 137,000 men who received external beam radiation,
prostatectomy (surgical removal of the prostate) or brachytherapy
(radiation therapy administered directly to the tumor via
surgically implanted radiation-emitting "seeds"). They also
collected Medicare reimbursement records to determine the total
cost per patient per year for each of the three prostate cancer
treatments over time.
"We were able to get a good picture of the long-term costs of patient care and were surprised to see such dramatic differences among the three treatment strategies," Ciezki noted.
The study revealed that overall, just over 7 percent of the men
needed some type of follow-up treatment for a problem related to
their prostate cancer therapy.
Brachytherapy, the researchers noted, resulted in the fewest
number of toxicities involving their genital or urinary organs.
Just 3.4 percent of those treated with this therapy experienced
these types of problems, such as a narrowing of the urethra or
bladder bleeding. Brachytherapy also had the lowest cost per
patient per year of about $2,557.
A slightly higher number (6.7 percent) of those treated with
prostatectomy experienced problems with their genital or urinary
organs. This treatment, the study revealed, had a total cost of
about $3,206 per patient-year.
Meanwhile, just over 7 percent of patients who received external
beam radiation therapy had these adverse effects. This was also the
most expensive therapy, at $6,412 per patient-year. Similarly, 1.7
percent of patients who underwent the treatment had
gastrointestinal effects. In contrast, only 0.1 percent of
prostatectomy patients and 0.3 percent of brachytherapy patients
experienced these issues.
"We found that external beam radiotherapy had higher toxicity rates and was the most costly therapy per patient-year," Ciezki said. "While there are clearly still some high-risk prostate cancer patients who will benefit from external beam radiotherapy, for the approximately 80 percent or more of prostate cancer patients diagnosed with low- and intermediate-risk disease, brachytherapy or prostatectomy may be even more preferable options than we've previously assumed for men with low- and intermediate-risk prostate cancer."
The researchers pointed out they were not able to determine how
far the disease had progressed in each patient and the study was
limited to patients older than 65 whose only diagnosed condition
was prostate cancer.
They added their findings are preliminary and more research is
needed to investigate why the three prostate cancer therapies
produce different results and whether or not certain types of
patients are more vulnerable to the long-term effects of a
Experts said decisions about treating the individual patient
remain specific to that patient and his disease, however.
"The selection of treatment must include a detailed discussion addressing the life expectancy and comorbidities [other illnesses] of the individual, the natural history and curability of the disease, and how the potential complications -- like incontinence, lower urinary tract symptoms, erectile dysfunction and rectal symptoms -- will impact quality of life," explained Dr. Herbert Lepor, chairman of the department of urology and director of the Smilow Comprehensive Prostate Cancer Center at NYU Langone Medical Center, in New York City.
He added that while more study into the short- and long-term
side effects of different treatment options are sorely needed, the
new findings "come as no surprise to those of us who manage
prostate cancer based on the mechanism for radiation
therapy-induced cellular toxicity."
Another expert said the new study "makes strides towards
evaluating the relative effectiveness of treatments." Dr. David
Samadi, associate professor of urology at Mount Sinai Medical
Center, in New York City, said that "while external beam therapy
has an important role in the treatment of prostate cancer, these
finds suggest we should reserve it for patients who are unable to
tolerate other treatment options or have advanced disease, as in
the case of adjuvant or salvage therapy."
However, Dr. Louis Potters, chair of the department of radiation
medicine at North Shore University Hospital in Manhasset and Long
Island Jewish Medical Center in New Hyde Park, N.Y., said the study
may not be the final word on the issue.
"Analyzing claims data is a good way to 'see' how patients are treated. Yet, this type of study should not be used to imply that any one treatment is better than another," he said. "It is up to the treating physician to understand the risks of each therapy. And it's up to the treating physician to make cogent and unbiased recommendations to patients regarding their best outcome."
Findings presented at medical meetings are typically considered
preliminary until they have been published in a peer-reviewed
The U.S. National Institutes of Health provides more information
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