Myths about Brachytherapy

The following are some corrections and explanations to common myths regarding brachytherapy.

Myth: Young men should have surgery

Fact: Published data1-2,4,7 has demonstrated brachytherapy to be an excellent and equal or better 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 on the part of some physicians .A recent study showed that the 8 yr control rates for younger (<60 y/o) men were 92% vs 88% for > 60 y/o.. 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.1-2,4,7 Another recent study concluded that of patients with prostate cancer and treated with single (brachy, surgery or EBRT) 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.3 Bottom line is that if you are a younger man you should explore all the options.

 Myth: Surgery can not be performed after brachytherapy

Fact: This is not true. However most surgeons are not trained to do this procedure and it must be done by an experienced surgeon who has performed it many times before. The likelihood that a brachytherapy patient will face a local recurrence is quite low, approximately 3% 6. In the rare cases when there is a local recurrence only surgery can be done successfully. However, a local recurrence can be associated with distant recurrence which would make the value of removing the prostate in this situation questionable. Of note is that Prostate Cancer Center of Seattle physicians have developed and are treatign patients with local recurrence after external beam radiaiton or brachytherapy with focal , noninvasive treatments. See description on home page.

 Myth: Immediately after surgery, the surgeon says, “We got it all”

Fact: Microscopic disease beyond the gland cannot be seen by the naked eye, so this statement is a statement of hope, not fact. Only after a pathologic review of the removed prostate and subsequent PSA readings over 3- 5 years can this statement be given reasonable credibility The cure rates are excellent for many different treatment options, especially in low risk disease but it is a myth that surgical removal results in 100% cure.

 Myth: The seeds only work to contain cancer for 10 years, after which the cancer can come back

Fact: This statement is false and has no scientific merit. We currently have 15 year data to refute this statement. If you hear this statement, ask for a literature reference. Patients can fail any treatment years out and there is no point of an absolute cure for any treatment including surgery, but fortunately beyond 5 years the failure rate is quite low after seed implantation .

 Myth: A patient should not have sexual relations with his partner, because he can give prostate cancer to his partner

Fact: Prostate cancer, as well as other types of cancer, is not a contagious or infectious disease. It cannot be ‘spread’ by any type of physical contact with anyone.

 Myth: Once a patient has a seed implant, that patient is radioactive and should make sure his bodily fluids do not come into contact with anyone

Fact: The seeds are encased in titanium and there is no contamination of any bodily fluids, including semen, blood, sweat and urine. There is no way a patient can ‘contaminate’ any type of food or other products.

 Myth: Radiation, including the seed implant, makes a patient feel sick and causes his hair to fall out

Fact: The seed implant delivers low energy radiation to the prostate. This does not make a patient’s hair fall out or produce any type of physical change to his appearance. Unless a patient tells a person that he has had a seed implant, the person will never know. There are no visible side effects, scars or incisions that will suggest a patient has had a procedure. Many people mistake radiation therapy for chemotherapy, which is a treatment protocol in which drugs are used to systemically treat cancer. Chemotherapy can make a person feel sick and lose their hair. However, radiation therapy is NOT chemotherapy.

1. Ho, AY et al. Young Men have Equivalent Biochemical Outcomes Compared to Older Men After Treatment With Prostate Brachytherapy Volume 69, Issue 3, Supplement, Pages S90-S91 (1 November 2007)
2. Merrick, GS et al. Brachytherapy in men age less than or equal to 54 years with clinically localized prostate cancer. BJU Int’l (98), 324-328, 2006.
3. Frank SJ, et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. J Urol, Jun 177(6), 2151-6, 2007.
4. Sharkey J, et al. 103Pd brachytherapy versus radical prostatectomy in patients with clinically localized prostate cancer: a 12-year experience from a single group practice. Brachytherapy, 4(1): 34-44, 2005.
5. Ganswindt U, et al. Adjuvant radiotherapy for patients with locally advanced prostate cancer-a new standard? Eur Urol, Jun 23, 2008
6. Stone et al Int. . Radiation Oncology Biol. Phys. 76: p355-360 2010
7. Burri, R et al. Young Men have equivalent Biochemical outcomes compared with older me after treatment with Brachytherapy for PCa Int. J. Rad Onc. Biol Phys 2009 (article in press)