Yesterday I had a 66 year old patient visit me for a consultation. During our discussion, he revealed that he thought that brachytherapy was not an option for him. When I asked why, he said that his physician had recommended against it because, “if you have seeds, then you can’t have surgery later”.
This brings us to the “3 Myths Strike Again”. These are some of the myths out there concerning seed implantation.
1. If you’re young (under age 62) surgery is the best option.
This statement is false. Published data has demonstrated brachytherapy to be an excellent and equal treatment option for younger patients. There is no scientific data to suggest younger patients have better cure rates with surgery. This has long been a misconception. In fact, there are numerous studies that show that there are no differences in cure rates with young patients (age 62 or less), versus older patients, and all treatment options should be offered to patients. A recent study concluded that among patients with prostate cancer treated with a monotherapeutic approach, better urinary continence was exhibited in those who underwent radiation-based therapies. Furthermore, higher sexual function scores were seen in men who selected brachytherapy.
2. If you get surgery, you’re completely cured.
The fact is, cure rates for early stage prostate cancer have been proven equal for brachytherapy, surgery and external beam radiation. For a low risk patient, cure rates average 95% for all three treatments. A recent study determined that for low risk patients, brachytherapy resulted in 99% cure rates, while surgery resulted in cure rates of 97%. After radical prostatectomy, pathologically advanced disease is detected in 38% to 52% of patients. Therefore, although cure rates are excellent for many different treatment options, it is a myth that surgical removal results in 100% cure.
3. If you have seeds, you can’t have surgery.
This is not true, and in the rare case when surgery is needed after brachytherapy, it can be done successfully. However, it is important to keep in mind that having a local recurrence (when the cancer comes back in the prostate) is very rare. If prostate cancer treatment fails, it is usually metastatic (spreads outside the prostate). In such a situation, removing the prostate is of no value.