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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 brachytherapy.

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 particular treatment.

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 journal.

More information

The U.S. National Institutes of Health provides more information on prostate cancer.