Re the NEJM article, I agree it is a good one and, in fact, I had posted about it a year or so ago.
However, I guess there must be conclusions in the article that make everyone happy. While this study led NewspaperLover to the knife, it was one of the many reasons that I chose brachytherapy. For example, some of the comparisions between nerve-sparing prostatectomy and brachytherapy are as follows:
1. The "sexual score" (representing favorable quality of life) for nerve-sparing prostatectomy dropped after 2 years from 80 to 43, a decline of 46%. That same score for brachytherapy patients dropped from 67 to 45, a decline of only 23%. The reason the starting sexual score was different for the 2 categories is most likely because the average age of the surgery patients was 59, while the average age for brachytherapy patients was 65. The comparisons for non-nerve sparing surgery were even more dramatic.
2. The "urinary incontinence score" dropped from 96 to 80 (-17%) for surgery patients vs. a drop from 96 to 88 (-8%) for brachy patients. Likewise, the comparisons for non-nerve sparing surgery were even more dramatic.
3. After 2 years the percentage of surgery patients who either leaked >1 time per day, had frequent dribbing or any pad use was 39%. The brachytherapy group of older patients had 21% for the same categories.
4. After 2 years the percentage of surgery patients reporting "overall sexuality problems" had risen from 12% to 43%. In the older group of brachytherapy patients, the rise was from 18% to 30%.
5. After 1 year, spouse or partners of surgery patients reported either moderate or big problems with sexual functions in 50% of the cases. For brachtherapy spouses/partners, moderate or big problems were reported only 13% of the time.
Now, it may be that some of the sexual issues for brachytherapy show up after 2 years - though my doctor tells me that, for early stage guys, the problems usually manifest themselves within 2 years or not at all.
For those of us who have already made our choices, this debate is moot. However, for any patients considering future treatment, I would encourage them to read this important study on quality of life and reach their own conclusions.
Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Regular activities resumed, everything continues to function normally as of 9/1/09. 6 month PSA 1.4 and my docs are "delighted"!