Video: Prostate Brachytherapy for the Teal Stage of Prostate Cancer

THE STAGING GUIDE VIDEO SERIES | TRANSCRIPTION:

Hi, I’m Dr. Scholz.  Let’s talk about prostate cancer.

Brachytherapy seeds will be the first in this series because in many ways in can be argued to be the best treatment or at least the best standard treatment for Teal.  Treatment for Teal involves a variety of comparisons and choices.  There are more options for Teal than for any other stage.  This video is going to simply cover radioactive seed implants.  This is not to imply that in some cases other individuals with other situations of Teal might not need a different type of therapy. So the decision making for Teal is not an issue of right or wrong, but one of being better or worse compared to the other treatment options.  There was a time actually before robotic surgery came along that permanently seeds were the most popular treatment, but due to the financial incentives either beam radiation such as IMRT or surgery became much more popular.  Surprisingly, studies contradict that decision. Studies show higher cure rates and lower side-effect rates with seed implants when compared to either surgery or beam radiation.

Permanent seeds are administered as an outpatient procedure.  They can be done under limited anesthesia. Skillful seed implanters can do a permanent seed implant in less than an hour.  This sort of convenience contrasts sharply with beam radiation which might take 5-9 weeks, and surgery which requires a catheter for a week afterwards and recovery periods that may take months or in some cases years.  It’s not more expensive, seed implants are relatively economical.

What are the negatives about seed implants?  Men that have very large prostates or men that have a lot of pre-existing urinary problems could experience worsening of those symptoms with seed implants.  Sometimes detractors complain about the possibility the seeds migrating outside the prostate. This indeed used to be a problem, but now with modern technology they’ve strung them together so that no longer happens. The other concern is radiation emitted around the patient since the radiation remains in the patient as he walks around for the next 30 days or so, but the radiation only travels a centimeter or two and it doesn’t get outside the body.  Permanent seed implants do not cause radiation exposure to surrounding people.

Like all types of prostate cancer treatment seed implantation is a skill, and you need to go to experienced skilled practitioners to have it done properly.  One thing that is always important to remember when selecting treatment is to select a physician with a lot of experience and known special skills. Every type of treatment requires skillful administration and the possibility of mistakes and less-than-proper administration are a genuine risk.  

So in summary, seed implants compared to other options tend to be more convenient, tend to have fewer side-effects, and tend to have higher cure rates than all the other options.  In addition, although insurance covers most of these things, if you look at the actual costs they are lower than the other options. Unfortunately they are under-utilized because the industry more attuned to using other types of treatment that actually reimburse better for physician salaries and payments.

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