Permanent seed implantation, also known as brachytherapy, involves the insertion of small, carefully spaced, radioactive pellets into the prostate. After implantation, the seeds emit a low but continuous energy over a period of two months, which accrues to a large total dose of radiation inside the prostate. Seed implants are performed as an outpatient procedure, which takes about 60-90 minutes.
On average, cure rates from seed implants are superior to either surgery or IMRT. This bold claim is based on the findings of the Prostate Cancer Results Study Group, a compilation of every reputable study performed that reports cure rates. In addition, a randomized study called the ASCENDE-RT trial was completed which arrived at the same conclusion. Here are the findings of the ASCENDE-RT trial:
CURE RATE AT 5 YEARS
IMRT + hormone therapy: 84%
IMRT + hormone therapy + seeds: 96%
CURE RATE AT 9 YEARS
IMRT + hormone therapy: 70%
IMRT + hormone therapy + seeds: 94%
This randomized study demonstrates a dramatic 24% improvement in cure rates in patients who received a seed implant compared to those who received IMRT without seeds.
What is the status of seed utilization in the United States? Shockingly, there has been a dramatic decrease in the use of seeds between 2002 and 2010. Prostate treatment has migrated away from seed implants, not because of science, but because of economics and politics. All the other treatments pay doctors at a much higher rate. It’s interesting to note that the popularity of brachytherapy is growing rapidly in many countries, where physicians are paid the same rate regardless of which treatment is selected.
ABOUT THE AUTHORS:
Peter Grimm, MD was a radiation oncologist in Seattle, affiliated with Swedish Medical Center-Cherry Hill. He received his medical degree from Chicago College of Osteopathic Medicine and was Adjunct Assistant Professor of Radiation Oncology, UCLA Department of Radiation Oncology. He practiced 36 years as a seed implant expert. He received various awards including an American Cancer Society Fellowship and the President’s Award from the American Brachytherapy Society. He held at least six patents related to radioactive seed implantation and authored or coauthored more than 60 peer-review publications. Dr. Grimm also created a popular prostate cancer educational website that provides comparative outcomes for many types of treatment: www.pctrf.org.
John C. Blasko, MD is the former director of clinical of research for the Seattle Prostate Institute and a clinical professor in the Department of Radiation Oncology at the University of Washington School of Medicine. A member of the board of directors of the American Brachytherapy Association, Dr. Blasko has published several hundred articles, abstracts, and book chapters on the subject of radioactive seeding. He received his medical degree from the University of Maryland School of Medicine, and served his residency at the University of Washington School of Medicine.