Why I Chose Radiation Seed Implants over Prostate Surgery

In late 2010, based upon higher than normal PSA numbers, my family physician suggested I meet with a Urologist. Further testing by my Urologist led to a biopsy in early March... a none-too pleasant experience with a great deal of pain, swelling, a visit to the emergency room, catheter placement for two days and blood in my urine for several weeks.

On April 1st, 2011, I was diagnosed with Prostate Cancer. As a relatively young man in my early 50's, you can imagine that I was quite devastated. With a Gleason score of 6, and being in relatively good health, I was given quite a few options for my treatment. The "watchful waiting" approach was not for me... my family physician lost a young patient who waited to long. I was going to be aggressive in my approach.

My first conversation was obviously with my Urologist. To be completely honest, I was rather put off when he went quickly went through the various treatment options and immediately suggested radical prostatectomy (he would be happy to perform the operation). No thank you.

After reading tons of online documentation, and at the suggestion of my family physician, I next visited Penn Medicine in Philadelphia, which is using an ultra-modern new method of external beam radiation using proton beams. This method is apparently more targeted and leads to less tissue damage (outside of the prostate) than traditional external beam radiation. But, unfortunately, like traditional external beam, it takes 40 sessions... 5 days a week for 8 weeks. As an advertising sales executive who makes a commission-based living on the road, this seemed like a very difficult choice to make.

I next consulted with Thomas Jefferson Hospital in Philly. I was immediately put at ease by Dr. Edourado Trebulsi, one of the foremost Urologists in the Delaware Valley, with vast experience in robotic prostatectomies. Rather than pushing me towards surgery, which several other Urologists have done, he actually said to me that his profession has been rightly criticized by the rest of the medical community for being "too quick to cut" (I'm paraphrasing). My thoughts were immediately, "if I am to choose surgery, this is the gentleman I want to do it." Surgery sounds simple easy... cut out the cancer! The problem with surgery, as anyone who has studied the issue can attest to, is that it is not only a very serious and sometimes risky operation, 20% of men experience nerve damage and permanent impotence. Add to that wearing a catheter for up to two weeks and incontinence for many months after. It is a very serious decision. Radiation has its own issues. Surgery afterwards radiation is not an option. Permanent scar tissue, etc. Dr. Trebulsi arranged a multi-discipline consult for me, for which I am very grateful. I met with several doctors, including radiation oncologists. One concern in my case for radiation was my very difficult experience with the biopsy. It was thought that seed implants (LDR Bracytherapy) could cause a similar and perhaps worse, swelling.

Two weeks later, after a lot of mediation and thought, I had just about made up my mind to choose surgery. But something was nagging at me. For one thing, surgery has an almost identical rate of cure as radiation, with far greater side effects. I was just about to call Dr. Trebulsi to schedule surgery when I thought, "You know what? I will always regret it if I don't look one more time into radiation." I realized that I still hadn't contacted the world-famous Fox Chase Cancer Center, right here in the Philadelphia area. I read that Dr. Eric Horowitz and his team of radiation oncologists were some of the best in this field.

I arranged a consult and was pleased to meet with Dr. Horowitz personally. I asked him about my experience with the swelling, and he asked me I was given Flomax before and directly after the biopsy. When I told him, "no", he said that Flomax may have very likely prevented the swelling. A urologist at Fox Chase also suggested that is also possible that problems occurred with the actual biopsy. Dr. Horowitz said that not only was he not worried about the swelling; in fact, I was an almost ideal candidate for radiation seed implants, based on the size of my prostate, my low Gleason score, my PSA numbers and other factors. I breathed a sigh of relief. After all, radiation seed implantation is one the least invasive of all treatment options, with some of the fewest side effects. I mentioned that the radiation oncologists I spoke with at Penn Medicine told me that seed implantation is not as targeted as external beam. Dr. Horowitz smiled and said, "It depends who is doing the procedure." (Dr. Horowitz does both seed implants and external beam.) Radiation Seed implantation (LDR Brachytheraphy) is one of the oldest treatment methods for prostate cancer and the technology improves with each passing year. It is, in fact, very targeted, if performed properly. The prostate is very carefully mapped out before and during the procedure.

On October 12, 2011 (Columbus Day), I was treated with Iodine-125 seed implants at Fox Chase Cancer Center by Dr. Horowitz and a great staff. Everything went very smoothly (aside from the after effects of the general anesthesia and some pain). Very little blood in the urine. I took Flomax for several days prior to the procedure and will continue for some time after. So far, no swelling. I was released the same day. I am very hopeful for a full recovery.

Many of you reading this post are no doubt aware of the recent recommendations by the United States Preventive Services Task Force against PSA testing for healthy men. I am not a doctor; but I believe that these recommendations were not only very poorly explained, but even possibly irresponsible. While it is true that PSA testing is imperfect, it is a very good indicator of possible cancer. Until someone comes up with a better test, it is all we have. More importantly, the data from which they drew their conclusions is possibly flawed... focusing on older men. European studies with younger men have drawn different conclusions. While it is also true that men diagnosed in their mid to late 70's are more likely to die with prostate cancer than from the cancer, since it is generally (but NOT always) a slow-growing cancer, what about younger men? While for only a minority of cases does the cancer becomes metastatic, for those men, this is often a death sentence. Frank Zappa died at age 52. Cancer cells can leave the prostate and find new homes in soft tissue, especially lymph nodes and bones, resulting in a very painful death. Without the PSA testing, diagnosis and treatment, how would those men's lives be saved? Prostate cancer is the second-leading cause of cancer deaths among men.

In closing, I DO completely agree with the criticism regarding urological physicians who too easily push for surgery. It is currently the most common form of treatment among younger men. I personally believe that it is way overly-recommended. I believe that due to the serious side effects of the surgery it should be perhaps the last option chosen. Consider this... if radical prostatectomy has a similar success rate as the latest radiation procedures (90+%), what conclusion can you make? Further advancements are being made each year to improve success rates. Again, while I am not a doctor, it seems fairly obvious that in the 10% of cases where neither treatment is successful, the cancer very likely already become metastatic and left the prostate, and it may not have mattered which treatment method you chose. Therefore, I highly recommend that you speak with several radiation oncologists to learn if you are a good candidate.

Men of ALL ages over the age of 49, until a better method is found, GET YOUR PSA TEST ANNUALLY. And if you are diagnosed, do your research. Meet with multiple urologists and radiation oncologists to determine the best course of treatment for YOU.