A PROSTATE cancer treatment used far less frequently than surgery could be the more effective response, a review of studies that included more than 50,000 patients has found.
Men who had their low- to medium-risk cancer treated with brachytherapy - where tiny seeds of radioactive material are placed inside the prostate - were less likely to show signs it had returned than those treated with radical prostatectomy or external radiation, the international research team found.
Men with high-risk cancer benefited most from a combination of hormone deprivation therapy, external radiation and brachytherapy, according to the review, published in the journal BJU International.
Brachytherapy is less likely to cause some of the side-effects of prostate cancer treatments.
In 2010 there were about 740 instances of brachytherapy seed implantation paid for by Medicare, according to Medicare figures
In the same period there were more than 3230 claims for radical prostatectomy.
The chairman of the Australasian Brachytherapy Group, Joseph Bucci, said it could be difficult for patients to access brachytherapy, and it was only publicly funded in low-risk cancers.
"But I think this paper really starts to refute surgery as being the gold standard," he said.
Dr Bucci said if a man decided to go ahead with brachytherapy - men are often advised to instead monitor the cancer to see if it develops - the implantation of about 80 to 100 radioactive seeds was minimally invasive compared with other treatments. However, side-effects included making urination difficult.
"The outcomes of prostate cancer are measured over the course of a decade, so quality of life becomes a big issue for these men," he said.
But the president of the Urological Society of Australia and New Zealand, Dr Stephen Ruthven, cautioned that the studies included had a minimum median follow-up of patients of only five years.
"[The research] does create as many questions as it answers in terms of the poor patient trying to make up his mind," he said.
It also measured cancer survival based on measurements of levels of a protein in the blood - prostate specific antigen (PSA) - that indicated the likely presence of cancer rather than why they actually died.