Title: Ten-year disease free survival after transperineal sonography-guided iodine-125 brachytherapy with or without 45-gray external beam irradiation in the treatment of patients with clinically localized, low to high gleason grade prostate carcinoma
Abstract: In their article, Ragde et al. employ classic techniques of misinformation in their attempt to show that implants have better results than external beam irradiation. Their group of patients, who have favorable prognostic features, are compared with my series of patients of all stages and grades. The reference they selected to quote is an older one; it demonstrated that conformal treatment produced higher 5-year bNED rates than conventional treatment. I will not comment on the inappropriate use of Stamey's work as representative of radiation therapy or defend other institutions whose work has been similarly distorted. Table 1 compares the data of Ragde et al. with various endpoints for the 1995 reference quoted and a more appropriate 1997 publication of our work. Our 1997 data show that 61% of all patients are bNED at 5 years compared with 74% and 71% for Ragde et al. This is remarkably good, considering that twice as many (57% vs. 29%) of our patients had prostate specific antigen (PSA) levels >10 ng/mL and one-fourth (9% vs. 38%) as many had favorable <4 ng/mL levels. PSA is the strongest independent predictor of failure. Our series had nearly twice as many T1 patients (30% vs. 17%) but 6 times as many T3 patients. When external beam irradiated patients with favorable tumor characteristics are compared with the favorable or total implant group, 5-year results with the external beam irradiation are actually numerically higher, as shown in the table. The statements by Ragde et al. and subsequent newspaper quotations about external beam irradiation are not accurate and have caused many patients needless worry about the treatment they have received or are considering. An improved or equally effective new treatment can stand on its own merits and does not need to be justified by a distorted interpretation of the findings of other studies. Gerald E. Hanks M.D.*, * Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania