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Point: Prostate carcinoma treatment for the young patient—The case for brachytherapy

  • Kent E. Wallner
    Correspondence
    Corresponding author. Radiation Oncology, Department of Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108. Tel.: +1-206-768-5356; fax: +1-206-768-5331.
    Affiliations
    Radiation Oncology, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA
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      A growing number of long-term series document highly favorable outcomes after brachytherapy or prostatectomy for low-risk prostate cancer (
      • Merrick G.
      • Wallner K.
      • Butler W.
      • et al.
      Brachytherapy in men aged ≤54 years with clinically localized prostate cancer.
      ,
      • Twiss C.
      • Slova D.
      • Lepor H.
      Outcomes for men younger than 50 years undergoing radical prostatectomy.
      ,
      • Rosser C.
      • Kamat A.
      • Wang X.
      • et al.
      Biochemical disease-free survival in men younger than 60 years with prostate cancer treated with radical prostatectomy.
      ). And unlike the case for external beam radiation, the effectiveness of prostate brachytherapy can be measured by post-treatment prostate-specific antigens that match those of prostatectomy (
      • Kuban D.
      • Levy L.
      • Potters L.
      • et al.
      Comparison of biochemical failure definitions for permanent prostate brachytherapy.
      ). Studies documenting long-term cancer control in younger patients specifically are more limited, but available evidence is that the prognosis for younger patients with either surgery or brachytherapy is similar to that for older patients (
      • Merrick G.
      • Wallner K.
      • Butler W.
      • et al.
      Brachytherapy in men aged ≤54 years with clinically localized prostate cancer.
      ,
      • Twiss C.
      • Slova D.
      • Lepor H.
      Outcomes for men younger than 50 years undergoing radical prostatectomy.
      ). Quality-of-life outcomes also seem similar between modalities overall, regardless of age (
      • Sanda M.
      • Dunn R.
      • Michalski J.
      • et al.
      Quality of life and satisfaction with outcomes among prostate-cancer survivors.
      ,
      • Jani A.
      • Parikh S.
      • Vijayyakumar S.
      • et al.
      Analysis of influence of age on acute and chronic radiotherapy toxicity in treatment of prostate cancer.
      ). Although excellent outcomes can be achieved with surgery or brachytherapy in younger prostate cancer patients, it has become clear that achieving those outcomes with either modality is quality dependent.
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