I will give you a completely biased view of Brachytherapy. This bias was not easily reached as it entailed hundreds of hours of research, talking to surgery and Brachy patients and reading hundreds of posts on forums like this. This bias was reinforced by my own experience.
The following studies regarding cure rates are peer reviewed.
Prostate Cancer Foundation of Chicago, 2009: 9137 patients, 11 year follow up: Low risk 96%; intermediate 84%, High 75%
Cleveland Clinic; 11 years; low 96% intermediate 84% high 71%
MSK, 1829 patients, 5 years; "Reoccurrance rates are similar with surgery, Brachytherapy and External Beam"
Journal Of Urology, 173, 2005 12 years, 1449 patients. 89% low, 78% intermediate, 63% high; overall 93% disease free survival.
Seattle Prostate Institute; 10 years: metastic free survival 97%; local control 97%
Prostate Cancer Study Group, 2009: Brachytherapy or Brachy with IMRT. Biochemical Free after 10 years higher than all other treatment forms.
ICER. Dec 2008; "Brachytherapy is the most cost effective method of treating prostate cancer"
At worse Brachytherapy has similar cure rates as surgery at all risk levels and data indicates it is slightly better than surgery.
Tud's post will point out the differences in side affects, but here are a few things to consider:
Brachy incontinence rate is about
1%; Surgery has severe incontinence at 2 years of 10% and the chance of being leak free at 2 years is only 28%. You will be incontinent for at least a few months in the best of situations.
I arrived for my seed implant at 9am and by 12 I was having lunch in a resturant and played golf the next day. Try that after surgery. You won't even be off the table by then and will have to spend at least 2 to 4 days in the hospital and have a several week recovery.
I have no side affects, never had ED or any incontinence from day 1 and never had to fool around with a catheter.
Yes, I'm biased, how could I not be.
64 years old.
PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.
2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.
Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.
Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.
25 treatments of IMRT 6 weeks after seed implants. No side affects at all.
PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.