Long-term oncologic outcomes of radical prostatectomy compared with brachytherapy-based approaches for intermediate- and high-risk prostate cancer

Purpose: To review the recently published contemporary long-term outcomes from tertiary care urologic practices comparing brachytherapy-based management strategies and radical prostatectomy (RP) across intermediate- and high-risk groups.

Methods and materials: Literature was reviewed for the past 5 years under the search terms localized prostate cancer, outcomes, brachytherapy, and adical prostatectomy. Abstracts were reviewed and excluded if results were not reported according to the recognized risk groupings or if followup was less than 5 years.

Results: A total of 1237 abstracts concerning adical prostatectomy and 600 concerning brachytherapy were retrieved in the initial search. Of these, 80 met the inclusion criteria, and the articles were retrieved and reviewed in detail.

Conclusions: For intermediate- and high-risk prostate cancer, brachytherapy-based approaches provide superior long-term oncologic and functional outcomes. Irritative and obstructive symptoms are prominent in the first 6-12 months but resolve by 3 years for all but <5%. High-risk patients do very well with multimodality treatment combining external beam radiotherapy, a brachytherapy boost, and androgen deprivation for 9-12 months.