“The pros and and cons of prostate cancer treatment options”

The Johns Hopkins Health Alerts yesterday issued a new summary of the up- and the downsides of the four “standard” treatments for localized prostate cancer: active surveillance, radical surgery, external beam radiation therapy, and brachytherapy (with permanent seed implantation).

You can read the complete summary on the Johns Hopkins Health Alerts web site.

The summary is broad, and does not get into any detail about differences in outcome based on different types of surgery (e.g., robot-assisted vs. open) or radiation (e.g., photon- vs. proton-based) or the skill of the physicians involved. It also makes no reference to such evolving options as focal therapy or whole-gland high-intensity focused ultrasound.

It is based on the assumption of first-line monotherapy and does not address the patient’s risk category. It is therefore most appropriate to use this summary as a guide primarily for men considering their options when they have very low-, low-, and intermediate-risk forms of prostate cancer. (However, men with early stage, high-risk disease can sometimes be good candidates for first-line monotherapy with surgery, external beam radiation, and brachytherapy.)

In general, we would consider this to be a “fair” summary that does indeed balance the pros and cons of these four approaches to the management of patients initially diagnosed with localized prostate cancer.

4 Responses

  1. What about HIFU?

  2. HIFU is certainly not a “standard” treatment for localized prostate cancer in the USA at this point in time.

  3. Claim for surgery: “Erectile dysfunction: 30-50% at 5 years (with nerve preservation)”
    And for radiation: “Erectile dysfunction: 30-50% at 5 years”
    And for brachytherapy: “………”

    So … no ED with brachytherapy and amazingly low, but identical, levels for RP and EBRT. That’s amazing.

    Wonder how ED is defined for the purposes of this paper?

  4. Terry: It’s not a “paper” … and I think the answer to your question is “stuffable.”

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