PROSTATE CANCER ESSENTIALS

Introduction by Don Kaltenbach

A Personal Choice: Brachytherapy versus Surgery


When I was diagnosed with prostate cancer in 1990, brachytherapy (also known as radioactive seed implantation, or “seeding”) was still considered investigational, and there was little information available to patients about their treatment options. The PSA blood test had only been in use for a few years; in fact, I didn't even know my PSA reading prior to being treated. This field of medicine has changed dramatically during the last decade, and brachytherapy has now become the mainstream treatment of choice, surpassing surgery as the “gold standard” treatment for early stage prostate cancer.

The PSA test has enabled doctors not only to diagnose the disease earlier, but to more accurately determine the cure rates for each type of treatment. Back in the 1990’s, most men with early stage prostate cancers like mine were advised to have their prostates removed by the surgical procedure known as radical prostatectomy (RP). But more recently, the majority of patients have been choosing to avoid going under the knife, opting instead for sophisticated forms of radiation therapy, such as brachytherapy and dynamic Intensity Modulated Radiation Therapy (IMRT). These state-of-the-art therapies are often combined and have proven superior both in terms of cure rates and preserving quality of life.

Over the past decade, I have had a special interest in brachytherapy because this was the form of treatment that I chose for myself before the recent 10 and 12 year studies demonstrated its advantages over surgery. When first diagnosed, I was 44 years old, a family man with children still in diapers. Even though long-term results with brachytherapy had not yet been reported, I was determined to avoid, if possible, the risks of surgical side effects such as incontinence and impotence (now more accurately termed “erectile dysfunction”).

As I faced the crisis over a period of months and explored my options, preserving my quality of life was a personal priority as important to me as curing my cancer. I had been diagnosed with what was then called a “Stage B2” cancer (now termed “Stage T2c”) and was considered an excellent candidate for radical prostatectomy. But seeding made more sense to me after I did my homework and learned about the advantages of the procedure. In retrospect, I have no regrets whatsoever about the choice I made.

I had 63 seeds of Palladium-103 implanted without experiencing any of the complications or permanent side effects often associated with surgery and conventional external radiation. Since that time my PSA has been monitored annually, and I have been cancer-free for more than 14 years. With each passing year, I have become more convinced that I am cured, and that I made the right choice by resisting the advice of several urologists who did not adequately inform me about my options and tried to push me into having surgery.

Because of my positive experience and the favorable results with seeding being reported by leading medical centers, I became an activist and established the Prostate Cancer Resource Network, a non-profit foundation with a mission to educate patients and their loved ones. I also wrote a book recounting my personal journey (Prostate Cancer: A Survivor's Guide). In the fall of 2000, I gave up a successful law practice in order to help found and direct the Dattoli Cancer Center, which has become one of the country’s premier institutions for prostate cancer research and treatment. To this day, I continue to encourage men to seriously consider all of their treatment options, and to carefully examine the pros and cons of each before embarking on any course of action.

Seeding and IMRT are not appropriate for every patient. We have written this booklet to answer the most common questions about these procedures and to help you decide if either is right for you. Before deciding on any treatment, you should fully investigate the likelihood of cure and the risk of side effects that may alter your quality of life. These are the most important considerations in deciding on treatment. Given your age, your overall health, and the stage of the cancer, you will want to find a balance between effectiveness and side effects -- a balance with which you are comfortable, that you can live with both before and after treatment. Knowing what to expect each step of the way is one of the keys to fighting this disease.

You should also be aware that much of the information available on prostate cancer has been written with a definite pro-surgical bias. It is not surprising that surgeons continue to recommend surgery. Specialists tend to recommend their own specialties. If you have received advice from a surgeon, you should do yourself the favor of seeking a second opinion from a radiation oncologist, and vice versa. Each of these specialists will be better able to explain how and why he does what he does. The data and quality of life issues, however, will ultimately speak for themselves as you do your own research and compare the results for each type of treatment for which you may be eligible.
As members of the Dattoli Cancer Team, our shared goal with this booklet is to help you make informed decisions about your treatment. Don’t delegate those decisions to someone else. After all, it’s your body and your health that are at stake. As you gather information, always consider the source and use your own judgment about your personal needs. You will know best what is right for you. Don’t be afraid to voice your concerns to your doctor and don’t hesitate to ask questions – you have every right to know the answers and to expect a standard of care with which you are satisfied. It is our hope that those of us who have made this journey before you can help you find your way more readily, that the path will be easier for you, and your destination all the more sure.

Overview

Over the past decade, prostate brachytherapy has gained increasing popularity for the treatment of early stage prostate cancer, especially in light of the favorable side effect profile when compared to alternative treatment options. The number of patients treated with radioactive seed implants is now on a par with and surpassing both radical surgery and full-course external beam radiation therapy. This guide will present the basic principles, methods and data for patients who are considering brachytherapy either alone or combined with the most advanced form of external radiation therapy (IMRT).

The following is a Press Release from the Dattoli Cancer Center & Brachytherapy Institute Announcing Dr. Dattoli's latest research study:

Wednesday, July 13, 2005

Abstract Accepted for Prestigious ASTRO Meeting

Results of ongoing research into the efficacy of treating certain prostate cancers with combination therapy consisting of Palladium-103 brachytherapy (seed implant) and supplemental beam radiation, has been accepted for presentation at the annual meeting of the American Society of Therapeutic Radiation Oncology (ASTRO).

The meeting will be held October 16-20, 2005 in Denver.

Michael Dattoli, MD and Richard Sorace, MD have documented long-term (13 year actuarial) results of the combination therapy used in treating 282 patients with high risk disease. These were patients with high likelihood that their cancers had escaped the prostate and already invaded tissue beyond the gland. Factors that identified the men as high risk include PSA of 10 or higher and/​or Gleason scores of 7 or higher.

Patients were initially treated with the combination therapy in 1992. These patients are monitored annually for any evidence of disease recurrence. This study reports that the overall actuarial freedom from biochemical progression (disease recurrence) after 13 years is 81%.

The significance of this finding is huge. Remembering that these are all high risk patients and that their initial therapies were state of the art 13 years ago, the same grade patients (and those of lower risk) who are treated today with current combination therapy technology can expect even greater results.
In addition, the study reports that its failure rate drops to nearly zero after five years of follow-up. If the combination therapy holds the cancer at bay for the first five years, it is highly likely that the disease will not recur in later years.

For more information about the study, the combination therapy protocol or the Dattoli Cancer Center, in Sarasota at 941/​957-1221.