(ChemotherapyAdvisor) – A long-term analysis of more than 100,000 patients with prostate cancer treated with external beam radiotherapy (EBRT), prostatectomy, and brachytherapy found EBRT to be the most toxic and most costly, investigators reported during the 2012 Genitourinary Cancers Symposium.

The analysis, one of the first to examine quality of life and financial costs of three common treatment strategies for prostate cancer, suggests that for the approximately 80% or more patients with low- and intermediate-risk disease, “brachytherapy or prostatectomy may be even more preferable options than we’ve previously assumed,” said Jay P. Ciezki, MD, of the Cleveland Clinic, Cleveland, OH.

Dr. Ciezki and colleagues analyzed the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, which includes data collected between 1991 and 2007, for patients ages 65 years and older with prostate cancer (any stage) as their only diagnosis. Of the 137,427 patient records examined, 59,559 (43.3%) were treated with prostatectomy, 60,806 (44.2%) with EBRT, and 17,062 (12.4%), brachytherapy. No patient received combined therapy; median follow-up was 71 months. A therapy-related effect necessitated treatment intervention in 10,585 (7.3%). Within treatment modalities, the percentages receiving toxicity-related intervention were: RP 6.9%, EBRT 8.8%, and PI 3.7%.

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Brachytherapy had the lowest cost per patient-year, $2,557.36, followed by prostatectomy, $3,205.71, and EBRT, $6,412.29 (P<0.001). More treatment-related toxicities were observed with EBRT: 7.1% of patients experienced genitourinary toxicity, such as urethral strictures and bladder bleeding, vs. 6.7% for prostatectomy and 3.4% for brachytherapy (P<0.001).

Those treated with EBRT also had significantly higher gastrointestinal effects: 1.7%, vs. 0.1% of prostatectomy patients and 0.3% of brachytherapy patients (P<0.001). The most common GI toxicity was rectal bleeding requiring cauterization (0.8% of all patients).

Study findings are preliminary, the investigators noted.

The 2012 Genitourinary Cancers Symposium is sponsored by the American Society of Clinical Oncology, American Society for Radiation Oncology, and the Society of Urologic Oncology.