Radiotherapy can be delivered via external beam or seeds implanted into the prostate. External beam radiotherapy is not quite as effective as radical surgery in providing a cure, but has a slightly lower incidence of complications. Brachytherapy with radioactive seeds has the lowest incidence of complications. The results of brachytherapy are comparable to surgery in patients with well-differentiated cancers and low PSA levels. Brachytherapy is not suitable for patients with PSA levels above 10 and high Gleason grades.

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After treatment with curative intent with either surgery or radiotherapy the PSA should drop to an undetectable level. A PSA that fails to reach nadir level or rises after an initial drop indicate residual disease or metastases. The main cause of treatment failure is inaccurate staging prior to embarking on radical treatment.

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