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What is a Prostate Cancer Support Group?

Support groups connect people facing similar challenges. Members share experiences and advice with one another. Since 1998, ChicagoProstateCenter has hosted prostate cancer support group meetings once a month, where a physician and support staff are present to answer questions and discuss current research information, treatment options and what’s new in the treatment of prostate cancer.

CPC asked three patients who attend support group on a regular basis what this support group means to them and what their experience has been. Dick was diagnosed with prostate cancer fourteen years ago and has been attending CPC’s support group since 1998. Dick commented, “support groups keep me updated with prostate cancer and the different treatment options that are new.” Dick is also very grateful to have met amazing people throughout the years and loves helping men in need.  Eddie stated, “I was a basket case when I found out that I had prostate cancer. I didn’t know what to do, very nervous; it really helped having a hands-on physician to help answer my questions.” Eddie added, “it gives you piece of mind and it relaxes you knowing that there are different methods of treatment, and there are other men going through these same issues.” At the last support group meeting, Eddie brought a friend along and his friend was blown away that there was an actual physician there to answer any questions without having to make an appointment. Another regular attendee, Larry, who was diagnosed with prostate cancer seventeen years ago, said, “The urologist told me that I have only two years to live. I was nervous; looked into every type of option, saw specialists all around the world and even tried dieting (which did not work).” Four years of research later, he was treated with brachytherapy, which is radiation seed implants. The three patients all had the same outlook on the support group experience– that it is a wonderful place to meet new people, help men who have been newly diagnosed or were just treated with their questions.

If you have been diagnosed with prostate cancer and are looking to discuss treatment options, have had a recent seed implant or other treatment for prostate cancer and want to share your experience with others, if you want to listen, ask specific questions about treatment options or meet other patients, this support group is for you.  Spouses, partners, friends and family members are welcome to attend.

The staff and other guests are there to help answer questions and give the tools needed to make an informed treatment decision and maintain your current quality of life. We meet the first Wednesday of each month, at 7:00 pm at ChicagoProstateCenter in Westmont.  For details and dates for the upcoming support group meetings, please visit www.prostateimplant.com and click on the Upcoming Events page.

 

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Chicago Prostate Center’s View on Prostate Cancer Screening

Over the last few months, there has been a lot of controversy regarding the risks and benefits of prostate cancer screening.  According to a government advisory panel’s final report, doctors should no longer offer the PSA prostate cancer screening test to healthy men because they’re more likely to be harmed by the blood draw – and the chain of medical interventions that often follows -than be helped. Task force chairwoman, Virginia Moyer, a professor of pediatrics at Baylor College of Medicine in Houston, TX stated, “That’s because the PSA, which measures protein called prostate-specific antigen, often leads to unnecessary needle biopsies for men who don’t actually have cancer. Even worse, those biopsies lead many men to be treated for slow-growing cancers that never needed to be found and that are basically harmless.” Moyer hopes that physicians stop mentioning the PSA screening when seeing their patients.  However, Ian Thompson, chairman of urology at the University of Texas Health Science Center at San Antonio and spokesman for the American Urological Association commented, “Unfortunately, there are no other better tests with which to replace the PSA, such as rectal exams, ultrasounds or variations on the PSA.” Thompson also stated how he supported some of the task force’s recommendations, such as its call to do away with mass prostate cancer screenings in shopping malls and parking lots, but think they are going too far in rejecting the PSA test completely. Thompson does not want to go back to the “bad old days” before screening, when doctors found prostate cancer only after it had become incurable.

A study published in the March 2012 issue of the New England Journal of Medicine confirmed the benefits of prostate cancer screening.  An 11-year European analysis of 182,160 men found PSA screening to reduce deaths by 29% when compared to those men who did not undergo regular PSA screening.  The authors concluded that the question is not if to screen, but how and who should be screened.

ChicagoProstateCenter supports Dr. Thompson’s statement above and fully supports annual prostate cancer screenings to men over 50 years old.  Having treated over 15,000 men with prostate cancer, we have clearly seen the benefits of prostate cancer screening and treatment. Unfortunately, until we can clearly identify which cancers are indeed of ‘high risk/aggressive nature’ versus those that are ‘slow growing’, prostate screening is extremely valuable.  Therefore, most prostate cancer is treated the same way, in order to make sure the potential aggressive cancers progress and go untreated.  It is also important to include a digital rectal exam along with a PSA test for a more accurate assessment.  If a diagnosis is made, we encourage patients to explore all of their options and to make an informed decision regarding their health.  Furthermore, another benefit to obtaining annual PSA tests and rectal exams is that physicians can obtain a baseline PSA or status.  This way, they can track the PSA behavior over time, which is another indication or how fast or slow a potential cancer is growing.

If diagnosed with prostate cancer, CPC believes the decision of whether or not to treat to cancer should be left up to the patient.  If a patient chooses a ‘watch and wait’ approach and delay any intervention, our recommendation would be to undergo a more sophisticated prostate biopsy technique performed at ChicagoProstateCenter.  This is called stereotactic transperineal prostate biopsy (STPB).  This technique has many advantages, the first of which is its increased ability to identify occult or “hiding cancers”. Our research and the research of others have clearly demonstrated that the transrectal biopsy does miss a significant percentage of cancers that occur in the anterior or front portion of the prostate. Our data in over 2,200 patients suggests that as high as 40% of patients are thought not to have malignancy, but indeed do have malignancy. Our group has previously published this information in Urology and the Journal of Urology. The second advantage to having a prostate biopsy using the perineal approach is that the infection rate is essentially 0%. This is simply because the rectal wall or rectum in general is not penetrated by the biopsy needle. As we know, infection is not uncommon after transrectal prostate biopsy and unfortunately the bacteria that are currently being identified have significant resistance to commonly used antibiotics. Our initial experience using STPB was confined primarily to patients who were diagnostic dilemmas in that they had persistent elevation of PSA level, while the biopsies were negative. More and more commonly today, patients are requesting perineal biopsy as their initial biopsy technique. This is because they have learned of the mapping ability using this procedure.

Specifically, the STPB is able to accurately identify the location within the prostate from which the cancer was obtained. This has dramatic implications because one is then allowed to apply therapy to only the area of malignancy, while avoiding normal sections of the prostate gland that have been proven NOT to contain malignancy. A whole new field of oncology will soon appear, and that is the realm of focal therapy for prostate cancer. Finally, due to the comprehensive information that STPB establishes, one is able to make a decision as to whether watchful waiting is a viable option. Certainly this option is pursued by many individuals, however, with information based solely on transrectal prostate biopsy, one risks the possibility that a higher grade malignancy may also exist in the gland that was not identified. For these reasons, we think that STPB will definitely have a place in the future of prostate cancer diagnostics and therapeutics. With regard to prostate seed implants (brachytherapy), based on perineal biopsy data, there is no question that the implants today are much more sophisticated than those based on transrectal biopsies in the past.

Finally, it is important for patients to know that not all treatments for prostate cancer have the same outcomes or the same side effects.  Many men worry about incontinence or impotence and other quality of life issues.  Brachytherapy (seed implant) is a one time, out-patient procedure with cure rates that are equal to or better than surgery as well as traditional external beam radiation therapy (EBRT).  Brachytherapy is touted as the safest and least expensive of the three main treatments for prostate cancer, which also include radical prostatectomy and (EBRT).  Jay P. Ciezki, MD, from the Cleveland Clinic presented findings at the 2012 Genitourinary Cancers Symposium: He and his team looked at 16 years’ worth of claims-based data for 100,000 men with prostate cancer, and found that brachytherapy patients experienced the least toxicity requiring intervention, at 3.4%. For surgery it was nearly double that—6.7% of patients having prostatectomy had some problems with their genitourinary organs afterwards, as did 7% of men treated with external radiation.

In summary, brachytherapy can be done in any patient with prostate cancer. There’s not one patient that’s better treated with it than another. It’s really suitable for any patient who desires to avoid surgery and external radiation and to undergo a relatively easy-to-deliver treatment that’s going to have less impact, both long-term and short-term, on his lifestyle.

http://www.usatoday.com/news/health/story/2012-05-21/prostate-cancer-screening-test-harmful/55118036/1

The Case for Brachytherapy: An Interview with Michael F. Sarosdy, MD, Renal and Urology News, Delicia Honen Yard March 14, 2012

Schroder FH, et al.  Prostate cancer mortality at 11 years follow-up.  New England Journal of Medicine. March 2012; 15:366:981-90.

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Optimal Treatment for the Obese Patient

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.

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The Case for Stereotactic Transperineal Prostate Biopsies

By Brian J. Moran, MD

 Today, approximately 240,000 men will be diagnosed with prostate cancer. There remains a large group of patients, however, that are undiagnosed with this disease despite having had transrectal prostate biopsy. It is not uncommon for an individual to have a rising PSA level despite having had negative prostate biopsies where no carcinoma was identified. Stereotactic Transperineal Prostate Biopsy (STPB) uses a perineal approach, where the needles are placed through the skin below the scrotum and in front of the anus, to obtain specimens from the prostate. Ultrasound guidance is used and the patient is anesthetized at the time of the procedure.

This technique has many advantages, the first of which is its increased ability to identify occult or “hiding cancers”. Our research and the research of others have clearly demonstrated that the transrectal biopsy does miss a significant percentage of cancers that occur in the anterior or front portion of the prostate. Our data in over 2,200 patients suggests that as high as 40% of patients are thought not to have malignancy, but indeed do have malignancy. Our group has previously published this information in Urology and the Journal of Urology. The second advantage to having a prostate biopsy using the perineal approach is that the infection rate is essentially 0%. This is simply because the rectal wall or rectum in general is not penetrated by the biopsy needle. As we know, infection is not uncommon after transrectal prostate biopsy and unfortunately the bacteria that are currently being identified have significant resistance to commonly used antibiotics. Our initial experience using STPB was confined primarily to patients who were diagnostic dilemmas in that they had persistent elevation of PSA level, while the biopsies were negative. More and more commonly today, patients are requesting perineal biopsy as their initial biopsy technique. This is because they have learned of the mapping ability using this procedure.

Specifically, the STPB is able to accurately identify the location within the prostate from which the cancer was obtained. This has dramatic implications because one is then allowed to apply therapy to only the area of malignancy, while avoiding normal sections of the prostate gland that have been proven NOT to contain malignancy. A whole new field of oncology will soon appear, and that is the realm of focal therapy for prostate cancer. Finally, due to the  comprehensive information that STPB establishes, one is able to make a decision as to whether watchful waiting is a viable option.  Watchful waiting is NO treatment of the cancer. Certainly this option is pursued by many individuals, however, with information based solely on transrectal prostate biopsy, one risks the possibility that a higher grade malignancy may also exist in the gland that was not identified. For these reasons, we think that STPB will definitely have a place in the future of prostate cancer diagnostics and therapeutics. With regard to prostate seed implants (brachytherapy), based on perineal biopsy data, there is no question that the implants today are much more sophisticated than those based on transrectal biopsies in the past.

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‘Genetic Score’ May Improve Prostate Cancer Prediction

Karim Karer, M.D., PhD, and other colleagues from Wake Forest University School of Medicine in Salem, NC, analyzed data from 1,654 men who were a part of a prostate cancer clinical trial. The men in the study all had multiple negative biopsies, PSA screenings and received a genetic score based on testing of a panel of 33 single nucleotide polymorphisms that had been previously associated with prostate cancer.

The researchers found that, after adjusting the clinical factors and family history, the genetic score was a significant factor of a subsequent positive biopsy.

“Adding genetic markers to clinical parameters may improve cancer risk prediction. The improvement is modest but maybe helpful for better determining the need for repeat prostate biopsy,” Kadar and colleagues conclude. “The clinical impact of these results requires further study.”

Most of these diagnoses are made with a standard transrectal biopsy administered in the office by urologists. However, often times a patient will have a continued rising PSA, despite having had a negative office biopsy. This causes anxiety for patients and physicians. Fortunately ChicagoProstateCenter has developed Stereotactic Transperineal Prostate Biopsy, or STPB. This is the most comprehensive, sophisticated prostate biopsy technique available, diagnosing 40% more cancer than the standard transrectal office procedure —- cancer that would have otherwise gone undetected. The STPB procedure:

  • Diagnosing 40% more cancer
  • One-time, out-patient procedure (no hospital stay needed)
  • Minimally invasive (no incisions or stitches)
  • Performed under general anesthesia with no discomfort
  • Infection rate negligible
  • Confidence in exact location of cancer
  • Minimal, if any, post-operative pain
  • Return to normal activity within a day

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Senator John Kerry Leads Unanimous Passage Of The Legislation In U.S. Senate Urging Federal Research Support To Improve Early Detection Of Prostate Cancer

// BOSTON, July 30, 2012 /PRNewswire via COMTEX/ — U.S. CONGRESS SETS HISTORIC PRECEDENT IN RECOGNIZING HEALTH CARE CRISIS KILLING AFRICAN AMERICAN MEN DISPROPORTIONATELY

U.S. Sen. John F. Kerry (D-MA) led unanimous passage of the Senate Resolution 493 to recognize prostate cancer as an epidemic striking African American men disproportionately, with 250% higher mortality and 60% higher incidence. This bipartisan legislation urges federal agencies to support research for the advancement of diagnostic tools, including novel biomarkers and imaging technologies. Improved diagnostic tools will save lives and assure individualized, the least invasive and the most cost-effective patient care in millions of American men.

Senator Kerry said, “Prostate cancer is an epidemic – it kills every 16 minutes. This disease killed my dad, but I was lucky to beat it ten years ago, I introduced this resolution in the Senate to bring attention to this silent killer, how it disproportionately affects African Americans, and the need for additional federal investment in prostate cancer research, education, and awareness. I’ve been through the battle against prostate cancer and I understand the strain a diagnosis places on the patient and their loved ones. We need to stay focused on research and arm Americans with the tools to prevent, detect, cure and treat this disease, and I’m grateful to my colleagues and our advocates for pushing this resolution through.”

Dr. Faina Shtern, President of AdMeTech Foundation who worked with Senator Kerry and his staff for several years on prostate cancer research funding issues commented, “We applaud Senator Kerry’s leadership in national recognition of prostate cancer as a public health priority and a health care crisis in African American men. This legislation offers hope to millions of men who are left in the state of shock and confusion by the recent recommendation of the US Preventive Services Task Force against PSA screening, the only diagnostic tool currently available for early detection. Ending PSA screening is not the answer to the prostate cancer crisis. The Kerry resolution in support of research to improve diagnostic tools is.”

Prostate cancer is the most common malignancy in the United States, but federal research support is lagging behind, and men do not have reliable diagnostic tools. The impact is sobering: While prostate cancer is curable when detected early, it remains the second most lethal cancer in men, killing over 30,000 men each year.

Boston-based AdMeTech Foundation is a non-profit organization providing international leadership in prostate cancer research, education, and awareness (www.admetech.org ).

SOURCE AdMeTech Foundation

http://www.marketwatch.com/story/senator-john-kerry-leads-unanimous-passage-of-the-legislation-in-us-senate-urging-federal-research-support-to-improve-early-detection-of-prostate-cancer-2012-07-30

CPC agrees with Senator John Kerry. Early detection prevents unnecessary deaths from prostate cancer.

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Prostate cancer study questions surgery

A study that was reported in the New England Journal of Medicine has doctors divided. The study consisted of 731 men with the average age of 67, with only 10 percent under the age of 60, the implications for younger men who have more potential years ahead of them are less certain, experts noted. Researchers divided the group of men in half. Half of the men were assigned to have surgery, while the other half were assigned to watchful waiting. The group that was being observed had PSA testing every six months and every five years they did a bone scan to check for tumor spread. After 12 years, 47% of men who was treated with surgery died, compared to 49.9% of the men who were assigned to watchful waiting. There is not a significant difference between both options.

Based on their findings, Dr. Timothy Wilt, lead author on the study, stated that “observation is a wise and right decision for men with prostate cancer detected by PSA.” The article also stated that Dr. Wilt said his study agreed with the recent recommendation by the United Stated Preventative Services Task Force that PSA testing should not be used for young healthy men.

CPC encourages men to consult with their physicians and to get all of the facts, treatment options and make an educated decision that will benefit the patient.

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Benefits vs. harms of prostate cancer screening

According to government advisory panel’s final report, doctors should no longer offer the PSA prostate cancer screening test to healthy men because they’re more likely to be harmed by the blood draw – and the chain of medical interventions that often follows -than be helped. Task force chairwomen, Virginia Moyer, a professor of pediatrics at Baylor College of Medicine inHouston,TXstated, “That’s because the PSA, which measures protein called prostate-specific antigen, often leads to unnecessary needle biopsies for men who don’t actually have cancer. Even worse, those biopsies lead many men to be treated for slow-growing cancers that never needed to be found and that are basically harmless.” Virginia Moyer hopes that physicians stop mentioning the PSA screening when seeing their patients.

Ian Thompson, chairman of urology at the University of Texas Health Science Center at San Antonio and spokesman for the American Urological Association commented, “Unfortunately, there are no other better tests with which to replace the PSA, such as rectal exams, ultrasounds or variations on the PSA.” Thompson also stated how he supported some of the task force’s recommendations, such as its call to do away with mass prostate cancer screenings in shopping malls and parking lots, but think they are going too far in rejecting the PSA test completely. Thompson does not want to go back to the “bad old days” before screening when doctors found prostate cancer only after it had become incurable.

CPC supports men having yearly prostate screenings to detect prostate cancer. Early detection is the key to curing prostate cancer. Prostate cancer screenings, which include the PSA blood test and digital rectal exam, help detect prostate cancer in the earlier stages. Patients should be able to get all of the information possible to make an informed decision regarding their health. The above article states: “Because doctors today often can’t tell a harmless tumor from an aggressive one, they end up treating most men with prostate cancer the same, says Otis Brawley, chief medical officer of the American Cancer Society, which takes a neutral stand on the PSA.” We don’t know which ones are ‘harmless’ and which ones are ‘aggressive’, so that’s the problem, we don’t want to leave the aggressive ones untreated.

Also, the article only mentions the risk of death and side effects of surgery. Options such as brachytherapy have far less side effects and risk of death.

http://www.usatoday.com/news/health/story/2012-05-21/prostate-cancer-screening-test-harmful/55118036/1

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Prostate Testing and the Death Panel

This article appeared May 24, 2012, on page A17 in theU.S.edition of The Wall Street Journal, with the headline: Prostate Testing and The Death Panel.

By: TOM PERKINS

A recent announcement by the U.S. Preventative Health Service can rather simply be summed up: Most men eventually get prostate cancer, but most don’t die from it; those who do are mostly over 75 years of age, so that ends their continuing burden on the public purse. Further, early and prolonged testing is expensive, and can lead to medical complications from biopsy examination.

Happily I can report that I have successfully completed my 80th trip around the sun. A few years ago prostrate cancer was detected by my annual prostate-specific antigen (PSA) test; it was of a particularly aggressive type, as revealed by a routine biopsy.

That test led to surgery, radiation and hormone therapy.

Unfortunately, the cancer returned, and for the last couple of years I have been undergoing both routine and quite advanced experimental therapies, and everything has been monitored and controlled by PSA tests. Happily, the cancer has been knocked off its feet, and though not eliminated, it is controlled to the point that I am writing this fromFijiwhere I am actively scuba diving every day. (Fijiis a marvelous place for that sport, my favorite.)

Life is full of ironies. The PSA test was developed by a Kleiner & Perkins company, Hybritech, in the mid 1970s. How happy I am that Eugene Kleiner and I backed that effort so long ago; the partnership no longer has the remotest financial interest in the field, so these thoughts are not motivated by any residual economic involvement.

It’s hard to avoid a political aside, so I won’t try. A healthy market-driven free economy leads to innovation and the development of breakthroughs, like the PSA test. A highly taxed and highly regulated economy leads to “Death Panels,” like the U.S. Preventative Health Service.

Mr. Perkins is the founding partner of Kleiner Perkins Caufield and Byers, a prominentSilicon Valleyventure capital partnership. He is also a retired director of The News Corporation.

http://online.wsj.com/article/SB10001424052702304707604577422090223876520

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The Case for Brachytherapy: An Interview with Michael F. Sarosdy, MD

The Case for Brachytherapy: An Interview with Michael F. Sarosdy, MD

Delicia Honen Yard March 14, 2012

Having performed more than 1,200 brachytherapy treatments since 1996 and conducting research in this field, urologic oncologist Michael F. Sarosdy, MD, founder of South Texas Urology & Urologic Oncology, in San Antonio, is convinced that this is a far better choice than surgery for most men withprostate cancer, regardless of the patient’s age or tumor characteristics.

(Editor’s note: Dr. Sarosdy has no outside financial interest in any brachytherapy treatment programs, equipment, or services.)

Brachytherapy is touted as the safest and least expensive of the three main treatments for prostate cancer, which also include radical prostatectomy and external beam radiation therapy (EBRT). Does brachytherapy deserve this reputation?

Dr. Sarosdy: Absolutely. It’s very cost-effective and it has the least impact on day-to-day function in terms of treatment delivery. It’s a one-time outpatient treatment that requires about one hour in the operating room, under anesthesia, to implant the seeds, which are little titanium shells that contain radioactive material. The patient can quite literally return to work the next day.

Brachytherapy has become more sophisticated and polished in the 25 years since it was first used for prostate cancer. Physics planning software, technique, and ultrasound imaging have improved, and we’ve learned how to do the treatment more effectively and more safely. And now, some physicians are using real-time physics planning, where you do it right in the operating room instead of planning ahead of time and then trying to match up the image in the operating room with the image that was done for the preplan. This does makes the procedure take a little longer.

How often is brachytherapy used relative to other options?

Dr. Sarosdy: Brachytherapy has a very well-defined place in the treatment of prostate cancer. Over the past 10 years or so, there has been less brachytherapy done, because while robotic surgery has not been shown to be superior to open surgery, patients are less reluctant to undergo surgery with a robotic and laparoscopic technique. They feel less threatened by it, even though the fact is that it’s already been shown to have no higher cure rate. In fact, there are more frequent urinary complications with the robotic compared to open surgery.

Is there a clearly defined patient for brachytherapy compared with prostatectomy?

Dr. Sarosdy: No. Brachytherapy can be done in any patient with prostate cancer. There’s not one patient that’s better treated with it than another. It’s really suitable for any patient who desires to avoid surgery and external radiation and to undergo a relatively easy-to-deliver treatment that’s going to have less impact, both long-term and short-term, on his lifestyle.

The other reason that we’ve seen a decrease in the number of brachytherapy cases is that physicians—both radiation oncologists and urologists—have made a shift toward IMRT [intensity-modulated radiation therapy], for no other reason than that it’s reimbursed at substantially higher rates than brachytherapy. The cost for IMRT is about three to four times higher than the cost for brachytherapy, with no improvement in outcomes. Also, IMRT treatment delivery is somewhat onerous compared to brachytherapy: You have to go for nine weeks, Monday to Friday, to have the IMRT delivered, as opposed to one day for brachytherapy.

And there’s no data to support the idea that younger men should have surgery over brachytherapy or even IMRT. They actually have longer to live with the complications of surgery than older men—they have a longer time to be incontinent and impotent.

Kibel and colleagues reported in The Journal of Urology (published online February 15, 2012) that among more than 10,000 men undergoing radical prostatectomy, EBRT, or brachytherapy, brachytherapy was associated with decreased overall survival but not with prostate cancer–specific mortality compared with radical prostatectomy. (EBRT was also associated with decreased overall survival but increased prostate cancer–specific mortality.) Did you find anything remarkable about these results?

Dr. Sarosdy: Oh, I don’t think so. You can explain a lot of those findings. For instance, the overall survival was better with radical prostatectomy, but we tend to do that procedure in younger and healthier patients, and we tend to send patients who are older and have other morbidity issues for radiation therapy. That translates to what you see there in the difference in overall survival, because that’s not related to cancer-specific survival.

Jay P. Ciezki, MD, from the Cleveland Clinic presented findings at the 2012 Genitourinary Cancers Symposium: He and his team looked at 16 years’ worth of claims-based data for 100,000 men with prostate cancer, and found that brachytherapy patients experienced the least toxicity requiring intervention, at 3.4%. For surgery it was nearly double that—6.7% of patients having prostatectomy had some problems with their genitourinary organs afterwards, as did 7% of men treated with external radiation.

Brachytherapy usually is not recommended for high-risk patients, but a large study by Shen et al. (International Journal of Radiation Oncology, Biology, Physics; published online January 21, 2012) has found that brachytherapy alone or in combination with EBRT significantly reduced prostate cancer–specific mortality compared with EBRT alone. Does this finding surprise you?

Dr. Sarosdy: Not at all! There’s more and more data coming out that brachytherapy doesn’t need to be restricted to the low-risk patients; that it’s just as effective in high-risk patients. And we presented that data to the American Urological Association ourselves in 2007.

Brachytherapy is one of your main areas of clinical investigation, and in 2007 you concluded that testosterone replacement therapy could be used with caution and close follow-up after prostate brachytherapy. (Cancer 2007;109:536-541). What made this practice controversial?

Dr. Sarosdy: There was somewhat of a hysteria about giving testosterone to men who had been treated for prostate cancer since we know that testosterone fuels prostate cancer. And there had been two very, very small reports of testosterone therapy in men who had undergone radical prostatectomy, and then my report was one of a much larger series of men who in fact still had the prostate gland in place because they had received brachytherapy. That stimulated a tremendous amount of retrospective data analysis around the country, and several additional large papers have come out now, both after surgery and after radiation, showing similar outcomes. Particularly since we have PSA as a marker, we have something that’s sensitive and accurate to utilize in following these patients that we might need to treat for hypogonadism.

When you meet with a patient, do you go in with an assumption that you’re going to recommend brachytherapy unless something specifically contraindicates that?

Dr. Sarosdy: I come from a neutral stance, but the bottom line is that any rational analysis of treatment-related side effects compared to the efficacy of different forms of treatment would lead a thinking individual away from surgery to brachytherapy or to IMRT, for that matter. There is absolutely no proven superiority of surgery over the other treatments, and in fact the side effects are greater.

You also concentrate heavily on advanced bladder cancer. Does brachytherapy have a role there?

Dr. Sarosdy: There was some brachytherapy done inEurope in the 1970s for bladder cancer using an open technique: They opened up the bladder and implanted seeds, and some efficacy was demonstrated. The problem with bladder cancer is that it tends to be a much faster-growing tumor than prostate, so it doesn’t lend itself as well to slow delivery of radioactivity.

Will brachytherapy be used for any other urologic conditions?

Dr. Sarosdy: Probably not at the current time.

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