More men choose ‘seed’ therapy for prostate cancer
Last month, government officials revealed that Secretary of State Colin L. Powell was found to have prostate cancer. Like many of the nearly 230,000 American men each year who discover they have the disease, Powell elected to have the cancerous gland removed. This form of surgery, known as a prostatectomy, has long been considered the “gold standard” for treating prostate cancer, especially in its early stages.
Radiation treatments -- delivered from outside the body with beams of energy -- are another common treatment for prostate cancer. Now, however, a growing number of men with the disease are choosing an alternative known as brachytherapy.
In brachytherapy (pronounced “brake-ee-therapy”), radioactive material is placed in or near the diseased tissue, such as a malignant tumor. With prostate cancer, doctors insert tiny radioactive pellets, or “seeds,” into the gland, which destroy the cancerous cells. The implants, which lose their radioactivity in a few months, usually are permanent. (Less often, temporary seeds are used but are removed in a few days.)
In 1992, just 2% of men with prostate cancer who received radiation therapy underwent brachytherapy. By 1999, that figure had climbed to 36%. Brachytherapy advocates predict that the procedure soon will surpass prostatectomy as the treatment of choice for less advanced forms of prostate cancer.
Brachytherapy is not new; physicians first tried inserting radioactive materials inside the body to shrink cancerous tumors in the early 1900s. The technique wasn’t widely used to treat prostate cancer, however, until the 1980s, when improvements in medical technology made brachytherapy more effective. Ultrasound technology, in particular, allowed doctors to implant the radioactive seeds with greater precision.
“The cure rates for brachytherapy are at least as good as the other [procedures], if not better, with fewer chances of long-term complications,” says Dr. Gregory Merrick, director of Schiffler Cancer Center in Wheeling, W. Va., and a spokesman for the American Brachytherapy Society.
Evidence suggests that a man whose cancer hasn’t spread beyond the prostate stands about a 90% chance of being disease-free after five years whether he undergoes brachytherapy, traditional radiation or prostatectomy. Doctors who perform brachytherapy say the method offers several advantages over surgery and traditional radiation. Implanting 100 or so radioactive seeds -- each the size of a rice grain -- takes only about 45 minutes. A prostatectomy takes several hours to perform, after which the patient spends at least a few nights in the hospital and recuperates at home for as long as three weeks. External beam radiation requires daily visits to a clinic for eight to 10 weeks.
Erectile dysfunction is a common side effect of prostate cancer treatment. Early reports suggested that brachytherapy preserved sexual potency in 80% to 90% of cases, but Merrick says his research suggests that brachytherapy causes erectile dysfunction in about half the men who receive the implants. However, that compares favorably with other methods; for instance, only about 18% of men who undergo a prostatectomy can produce erections, he notes.
Although prostatectomy and traditional radiation often cause urinary incontinence, brachytherapy is more likely to cause the sensation of the need to urinate frequently, often accompanied by a burning feeling. Rectal bleeding is common too. These symptoms usually fade after a few months.
Controversy continues over brachytherapy’s value in treating advanced prostate cancer. “It’s not a good choice in a high-risk patient,” says Dr. Anthony V. D’Amico, an associate professor of radiation oncology at Harvard Medical School.
D’Amico published a study in the Journal of the American Medical Assn. in 1998 that showed that men with advanced prostate cancer who were treated with brachytherapy didn’t survive as long as men given other therapies. He prefers to treat men with more advanced prostate cancer with a combination of external radiation and hormone therapy.
However, proponents of brachytherapy say that if the therapy wasn’t working, more men with advanced prostate cancer who had undergone brachytherapy would be dying.
“That hasn’t happened,” says Dr. Stephen W. Doggett, a radiation oncologist at Cedars-Sinai Comprehensive Cancer Center in Los Angeles.
Changes in federal law that took effect this month eliminated caps on how much Medicare reimburses hospitals for the cost of radioactive seeds. In the past, these caps may have forced some physicians to limit the number of seeds they used per patient, says Dr. W. Robert Lee, a radiation oncologist at Wake Forest University School of Medicine in Winston-Salem, N.C.
Most doctors say men with larger prostates require a greater number of seeds for brachytherapy to be most effective. “This allows physicians to decide on a number of seeds that’s in the best interest of the patient,” Lee says.
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Timothy Gower can be reached by e-mail at tgower@comcast.net. The Healthy Man runs the second Monday of the month.
