Jan. 31, 2012 -- For most men with prostate cancer, having radioactive seeds implanted in the prostate is associated with fewer serious side effects than either surgery to remove the prostate or having a beam of high-energy radiation aimed directly at the cancer, researchers say.
The analysis of the Medicare records of more than 100,000 prostate cancer patients also shows that treatment with radioactive seeds, called brachytherapy, is cheaper than surgery or external beam radiation therapy (EBRT).
Studies have shown that all three treatments are "pretty much equally effective" for treating the 80% of prostate cancer patients diagnosed with low- and intermediate-risk disease, says researcher Jay Ciezki, MD, a radiation oncologist at the Cleveland Clinic.
"So it comes down to quality of life and cost. Based on our analysis, we have to conclude that brachytherapy is the optimal treatment choice," he tells WebMD.
An expert not involved with the work says the new study would not influence his choice of treatment for his patients, however.
Ciezki presented the findings at a news briefing in advance of the fourth annual Genitourinary Cancers Symposium, being held later this week in San Francisco.
Radiation Therapy Has Most Side Effects
Prostate cancer is expected to be diagnosed in more than 240,000 men in the United States in 2012, according to the American Cancer Society.
Ciezki and colleagues analyzed data on 137,427 men from National Cancer Institute Medicare data collected between 1991 and 2007.
Of the total, 43% of men were treated with surgery (called prostatectomy), 44% with external beam radiation therapy, and about 13% with brachytherapy. Researchers looked only at side effects that required a procedure to correct them.
Over a six-year period, on average, 8.8% who had external beam radiation therapy, 6.9% of patients who underwent surgery, and 3.7% who had brachytherapy needed a procedure to fix a therapy-related effect.
A total of 7.1% of patients who received external beam radiation therapy experienced problems such as incontinence or bladder bleeding, compared with 6.7% of those treated with prostatectomy and 3.4% of those treated with brachytherapy.
And 1.7% of EBRT patients had gastrointestinal side effects such as rectal bleeding, compared with 0.1% of prostatectomy patients and 0.3% of brachytherapy patients.
Brachytherapy was the cheapest treatment: $2,557.36 per year. Prostatectomy was slightly more expensive, at $3,205.71, followed by EBRT at $6,412.29.
Active Surveillance Also an Option
The researchers did not consider a fourth option: active surveillance. It involves close monitoring of the prostate tumor via tests, digital rectal exams, and intermittent biopsies with the intent of averting treatment unless the cancer progresses.
Active surveillance is a good option for men with smaller or slow-growing tumors or who have other medical conditions that might shorten their life span, Ciezki says. But many men who are good candidates don't choose it because of anxiety -- they feel they have to do something to treat a potentially growing cancer, he says.
Similarly, some men opt for surgery over other treatments because "they want the cancer out of their body," he says.
There are other considerations as well. Not every man is a good candidate for brachytherapy, for example: The cancer has to be confined to the prostate region and the man has to be able to undergo anesthesia, Ciezki says.
Andrew Lee, MD, MPH, a radiation oncologist at the University of Texas M.D. Anderson Cancer Center in Houston, says while the findings deserve more rigorous testing, they are in no way conclusive.
"The SEER-Medicare database offers very limited data, basing outcomes on procedural billing codes. We have no idea whether a patient had a side effect [that was treated with medication] or even whether the procedure is being done in the right setting," he tells WebMD.
Also, the study only looked at the records of patients treated through 2007. A more sophisticated technique of delivering radiation called intensity modulated radiation therapy has basically replaced conventional external radiation therapy over the past 10 years, Lee says.
A second study presented at the news briefing showed that men who get the newer radiation treatment are less likely to experience cancer recurrences or develop serious side effects than those who receive conventional radiation treatment.
Lee also says the side effect rates for all three procedures analyzed in the study are so low that the differences might not mean anything to a patient.
"All three procedures as well as active surveillance are appropriate in the right setting. Discuss the options with your doctor," Lee advises.
These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.