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May 5, 1999, Vol 281, No. 17 >

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Letters | May 5, 1999

Prostatectomy, External Beam Radiation Therapy, or Brachytherapy for Localized Prostate Cancer

Jerrold Sharkey, MD
JAMA. 1999;281(17):1583-1586. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-17-jbk0505.
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To the Editor: The article by Dr D'Amico and colleagues1 leaves the impression that only radical surgery is the solution for localized prostate cancer. However, the literature and their article confirm that for patients with PSA levels less than 10 ng/mL, prostatectomy, external beam radiation, and interstitial seed implantation are equal in "controlling" localized prostate cancer, but the differences in morbidities of impotence and incontinence strongly favor brachytherapy. For patients with PSA levels greater than 10 ng/mL, several studies show comparable results for all 3 therapies and some studies show better results with seeds,2- 5 especially with hormonal therapy or external radiation or both preceding brachytherapy. This contradicts the authors' contentions. Only randomized trials can settle this issue.3

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