Page 15 - PRESENTATION

Decision-Making Treatment Options (RT vs RP)

Advantages Disadvantages

External beam radiation therapy (EBRT) External beam radiation therapy

Effective long-term cancer control with high-dose treatments Significant risk of erectile dysfunction

Lack of lymph node removed; late rectal symptoms more common than
Very low risk of urinary incontinence
with brachytherapy or RP

Available for cure of patients over a wide range of ages and in those
with significant comorbidity Knowledge of possible metastasis to lymph nodes is not available

Up to one-half of patients have some temporary bladder or bowel
Brachytherapy
symptoms during treatment
Cancer control rates appear equal to surgery and EBRT for organ- Brachytherapy

confined tumors
Significant risk of erectile dysfunction
Quicker than EBRT (single treatment)
Lack of lymph node removed; knowledge of possible metastasis
Available for cure of patients over a wide range of ages and in those with to lymph nodes is not available

some comorbidity
Up to one-half of patients have some temporary bladder or bowel
Radical prostatectomy symptoms with treatment; there may be exacerbation of preexisting

Effective long-term cancer control lower urinary tract obstructive symptoms

Radical prostatectomy
Predictions of prognosis can be more precise based on pathologic

features in specimen Significant risk of erectile dysfunction

Pelvic lymph node dissection is possible through the same incision Risk of operative morbidity

PSA failure is easy to detect Low risk of long-term incontinence

16 Sanda MG et al. N Engl J Med 2008;358:1250