mule packer said...
If not it sounds like all the options have about the same success rates --mortality, ED and Incontinence in the long run.
I very much agree with Jim that there are major differences among treatments in their side effect profiles. Incontinence is virtually never a side effect of radiation, although urinary retention may be. SBRT and the brachytherapies have the lowest associated ED rates.
You are right that cancer mortality rates for intermediate risk are very low for any treatment; however, there are differences in treatment failure rates among the various treatments. This is often measured by "biochemical failure," which means PSA progression after treatment. Here are the 5-year freedom from biochemical recurrence rates (biochemical recurrence-free survival - bRFS) from some of the best practitioners for intermediate risk disease:LDR brachy(+IMRT) - 97%
- Taira et al, UW Seattle, 1656 men, 1995-2006, 12-yr bRFSHDR brachy (monotherapy) - 94%
- Rogers et al, GammaWest, SLC, 284 men, SBRT - 93%
- Katz, King et. al., 8 institutions, 1100 men, 2003-2012IMRT (86 Gy) - 86%
- Spratt et. al., MSK, 1002 men, 1997-2008, 7 yr bRFSIMRT (80 Gy) - 78%
- Zelefsky, et. al., MSK, 561 men, 1996-2000, 8 yr bRFS RP - 77%
- Hernandez, Partin, Han et al., Johns Hopkins, 6652 men, 1984-2005Proton - 65%
- Slater et al, Loma Linda, 1255 men, 1991-1997, PSA 10-20
These are not at all matched samples of men (e.g., men treated with RP and brachy are younger in general) and are not strictly comparable. The RCTs that will prove whether the differences are significant are many years away from maturing.