Low-dose-rate brachytherapy, radical prostatectomy, or external-beam radiation therapy for localised prostate carcinoma: the growing dilemma.

摘要

A man with a newly diagnosed clinically localised prostatic carcinoma may be overwhelmed by the extreme variety of therapeutic options, including low-dose-rate and high-dose-rate brachytherapy, radical prostatectomy (RP), either open or mini-invasive, external-beam radiation therapy (EBRT) with either three-dimensional conformal radiation therapy (3DCRT) or intensity-modulated radiation therapy (IMRT) technique, androgen-deprivation therapy and active surveillance.The elegant systematic review of Peinemann et al comparing LDR brachytherapy (LDR-BT), RP, and EBRT offers several reflections [1 ]. The authors refer to a dearth of long-term, adequately powered, randomised controlled trials (RCTs) analysing clinical outcome and toxicity profile following the three different treatment modalities. Of the 31 studies analysed, only one was in fact an RTC, whereas the remaining 30 referred to nonrandomised comparisons.