Prostate Cancer: Radiation Not Best
Men Treated With Surgery, Seed Implants Live Longer
Feb. 26, 2007 (Kissimmee, Fla.) -- External radiation therapy may cut
survival rates for men with early-stage prostate
These men are more likely to die over the next five years than those treated
with radioactive seed implants or surgery to remove the prostate, a new study
But even radiation treatment was highly effective, the researchers say.
After five years, 96% of the men who received seed implants and 98% of those
who had surgery were still alive, they report. In contrast, 94% of the men who
received external radiation were alive.
The findings suggest that "over the long term, the three treatments are
not necessarily equivalent in terms of overall survival," says researcher
Jay Ciezki, MD, a radiation oncologist at The Cleveland Clinic.
The study was presented here at the 2007 Prostate Cancer Symposium in
Newer Radiation Technique Used
The researchers studied 2,285 men with early-stage cancer that was still
confined to the prostate -- a group that accounts for about 80% of men
diagnosed with the disease.
Of the total, 1,053 men had surgery to remove the prostate. Six hundred
sixty-two were treated with seed implant therapy, or brachytherapy, in which
surgeons permanently implant tiny radioactive seeds into the prostate
The rest got external radiation therapy, usually with a newer type of
treatment known as intensity modulated radiation therapy, or IMRT, in which
multiple beams are focused at the prostate from many directions.
A computerized program allows doctors to adjust both the strength and the
intensity of the beams so that more radiation is blasted at the tumor and less
is delivered to critical surrounding organs such as the bladder and rectum.
Radiation Still Viable Option
After taking into account other factors that raise the risk of dying
(chiefly age, other illnesses, and smoking) the results showed that the
difference in survival rates among men given seed implants and surgery could
have been due to chance. But external beam radiotherapy proved inferior to
either of them, Ciezki says.
Eric Klein, MD, head of urologic oncology at The Cleveland Clinic, says that
all things being equal, surgery or seed implants are the treatments of choice
for most men. That said, radiation therapy should not be abandoned, doctors
Some men may not be fit enough for surgery or even the minor surgery
associated with seed implant therapy, says Deborah Kuban, MD, a radiation
oncologist at the University of Texas M.D. Anderson Cancer Center in
"For them, radiation is still the best option," she tells WebMD.
Radiation is also the treatment of choice if the disease has started to
spread to the edges of the prostate or the lymph nodes, she adds. "To be
able to offer a cancer patient a treatment that has a 94% cure rate is
wonderful," she tells WebMD.
Radiation May Miss Target
The researchers say they are continuing to follow the men to see if the
difference in survival rates persists over time.
They are also trying to figure out why the men who got radiation didn’t do
as well. One possibility is that despite newer techniques, some of the
radiation missed its target, damaging nearby tissue, says Klein. This, in turn,
can cause inflammation of the blood vessels, which can lead to blockages in or
hardening of the arteries, he tells WebMD.