Radiation therapy may be the best treatment for prostate cancer.
Between 1974 and 1994, Swedish researchers reported that death rates due to prostate cancer in the Swiss were the highest in the world, including 30 percent higher than in the U.S. At the same time, the number of prostate cancer cases among the Swiss population is about half of those in other countries. Consequently, the medical community is studying this phenomenon and weighing the benefits and risks of surgery versus radiation.
Surgery Versus Radiation
Swedish men have the highest rates of death due to prostate cancer.
After a study found that men are confused about what is an effective treatment for prostate cancer because urologists tend to recommend surgery and radiologists vouch for radiation therapy, Cleveland Clinic researchers examined the differences between surgery and radiation in patients over an eight-year period. Initially they found that surgery patients had a 2 percent advantage over radiation patients, but further study revealed that older techniques used in radiation therapy skewed the results. When they employed modern techniques and higher radiation dosages, surgery and external beam radiotherapy were equally effective.
Swedish Research
In 2007, Swedish researchers published the results of a long-term study comparing different prostate cancer treatments. The study found that after 10 years, men who had prostate surgery had an 83 percent survival rate while those who underwent radiation had a 74 percent rate of survival. However, this study occurred in the same time period in which Cleveland Clinic scientists found differing dosages of radiation in use.
Side Effects
A study published in the March 2008 issue of "The New England Journal of Medicine" took a look at the side effects associated with surgery, brachytherapy and conventional radiation treatment of prostate cancer. Brachytherapy is the implantation of radioactive pellets or seeds into a prostate to kill cancer cells. No one procedure stood out as the best or worst in terms of side effects, which can include urination problems, bowel movements and erectile dysfunction. About 13 percent of the wives of men who underwent brachytherapy reported erectile issues. In addition, 22 percent of spouses of men who underwent traditional radiation treatment and 44 percent of the surgery group reported erectile dysfunction concerns, while 15 percent of the surgery patients experienced urinary incontinence and between 6 and 10 percent of both the traditional radiation and brachytherapy patients reported incontinence. When pain and increased urinary frequency were included in side effects, about 18 percent of the men who used brachytherapy had moderate or negative results one year after treatment. Eleven percent of traditional radiation patients and 7 percent of surgical patients reported problems with pain or frequency of urination.
Radiation in Recurrence Treatment
A 20-year study published in the 2009 issues of "Radiotherapy" and "Oncology" found few complications and side effects associated with radiotherapy in prostate cancer recurrence. According to the study, radiation can eradicate recurrent cancer in patients who have had their prostate removed, and there is a narrow window of time in which external beam radiation can save lives. No other therapy has been shown to be effective in such cases of prostate cancer recurrence, the researchers said. The study began in 1987, and researchers say advances in radiotherapy likely have lowered the rate of side effects even more today.
Watching and Waiting
New Swedish research published in the 2010 "Journal of the American Cancer Society" found that even without any treatment, only 3 percent of men diagnosed with early-stage prostate cancer died within 10 years. Today’s improved prostate cancer screening means that many such cancers are found before they develop into a life-threatening disease. Still, radiation and surgery risk in these cases outweigh their benefits. The Swedish study reviewed death rates among 6,800 men who had been diagnosed with prostate cancer. About 20 percent of the men whose doctors used the "watchful waiting" approach died within eight years, but this number was no different, researchers said, than death rates among the general population. Less than 3 percent of those men actually died from prostate cancer, and those who died were typically in poor health beforehand.
