By Dr. Brian Moran
Prostate cancer remains the most commonly diagnosed cancer among men, aside from cutaneous non-melanoma skin cancer. The debate continues as to exactly as to which patients do benefit from prostate cancer therapy. Clearly there is a component of these cases that do require treatment, as if they are left untreated, can potentially be lethal. Once cancer is identified and sought to require treatment, a patient is confronted with numerous treatment options, ranging from radical surgery to seed implant therapy (brachytherapy) with a multitude of external beam radiation technologies available as well. There was a recent publication in the February 2012, issue of British Journal of Urology, by Grimm et al, that clearly demonstrated superior outcomes, using brachytherapy for low, intermediate and high-risk patients.
Given that brachytherapy is an excellent treatment option that can compete with any other of the options available, there are further considerations regarding patients co morbidly such as diabetes and heart disease. All of these factors need to be considered when proposing treatment to an individual for their malignancy. With regard to an individual who is over weight, surgery may be more difficult and external beam radiation can be more challenging for localization reasons. Prostate brachytherapy, however, is relatively immune to the patient’s body mass index. The reason for this is that the source of radiation is placed directly within the prostate, and one does not need to be concerned with beams of radiation traveling through, the patient’s body in order to reach the prostate. Naturally, when one is more obese, the distance from the skin surface to the prostate increases and this can increase the margin of error. With prostate seed implant the margin is negligible since the radiation again, is implanted directly into the prostate gland.
We have had an extensive experience here at ChicagoProstateCenter, treating obese patients ranging from mildly to profoundly obese individuals weighing in excess of 400 pounds. The patients have done well; there has not been any increased risk of side effects in this patient population. Therefore, when one is considering treatment of prostate cancer in an obese patient brachytherapy definitely needs to be considered.