How to select your brachytherapist

Who should you ask about finding a high quality brachytherapy specialist? Presumably a high quality brachytherapist! The following article is contributed by Michael F. Sarosdy, MD, who practices at South Texas Urology and Urologic Oncology, PA in San Antonio, Texas. Dr. Sarosdy is a board-certified urologist and was formerly professor and chairman of the Department of Urology, University of Texas Health Sciences Center, also in San Antonio.

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If you have recently been diagnosed with early stage prostate cancer, brachytherapy is one of several possible options. When it is properly executed, the treatment-related down time is nil, maintenance of quality of life is excellent, and the side effects of treatment should be minimal.

Like the majority of men who have prostate cancer, you were probably diagnosed by a general urologist to whom you were referred by your primary care physician, maybe after an annual “wellness physical.” While your general urologist may be knowledgeable about the options for treatment of prostate cancer, you should recognize that most general urologists do not treat more than 10 to 20 men in a year with either radical surgery or brachytherapy.

Although your general urologist may offer great office service, with a thriving and busy practice, the keys to success with any procedure for the actual treatment of prostate cancer are volume (i.e., the numbers of patient the specialist treats on a regular basis) and experience (i.e., how many procedures he or she has done altogether).

Urologic oncologists, who are doctors who specialize in management of urologic cancers, are best qualified to provide state-of-the-art care for prostate cancer. You should gather the early information about your cancer from your general urologist. Then, as you get over the initial shock and the dust starts to settle, seek out a second opinion from a urologic cancer specialist as well as a radiation oncologist experienced in prostate brachytherapy. A listing of urologic oncologists can be found on the web site of the Society of Urologic Oncology.

You also need to recognize that most urologic oncologists prefer to do surgery for prostate cancer, just as most radiation oncologists prefer to do radiotherapy. However, at least in the USA, larger metropolitan areas now usually have at least one team of physicians specializing in brachytherapy, and the key word is team.

The urologic oncologist and radiation oncologist who work together should both do a sufficient volume of prostate brachytherapies, and should be able to tell you about their total number of cases, the numbers of patients treated per year, and their volume over the last 5 to 10 years. They should do at least 75 to 100 implants per year, and hopefully more. They should also have no problem providing you with names and contact information for several of their patients who you can call for references.

Seek out those specialists who have published results in the peer-reviewed medical literature.

Ask your general urologist whom he would go to if he wanted to undergo brachytherapy himself. If he or she tells you one of his/her partners, verify that person’s credentials, but consider a second opinion from a urologic oncologist.

Additional information on brachytherapy and radiation oncologists who specialize in brachytherapy can be found on the websites of the American Brachytherapy Society, the patient support group SeedPods, and through the Seattle Prostate Institute.

Make absolutely certain that you are getting the most current information regarding the pros and cons of an implant. “Outdated” statements are often used to dissuade patients from seeking brachytherapy, including statements like the following:

  • “Implants cannot be performed after prior transurethral prostatectomy or TURP.”
    • This was true some 15 to 20 years ago, but modern implant design has changed that. Implants can now be done after TURP, and sometimes voiding symptoms and retention should be relieved first.
  • “Brachytherapy is OK for a small amount of Gleason 6, but anything worse should be treated with surgery.”
    • In fact, when patients have early stage cancers with higher Gleason scores, there is actually a greater probability of cancerous tissue being left behind after surgery than in the case of Gleason 6 cancers.
  • “Brachytherapy alone is OK for small amounts of Gleason 6 cancer, but anything more (higher volume or higher Gleason score) requires external radiation to be added to the implant.”
    • Again, this was true 15 to 20 years ago, but today brachytherapy alone is commonly sufficient, decreasing the side effects compared to brachytherapy combined with external radiation.
  • “Your best chance for cure is to remove it now … If brachytherapy fails, surgery can’t be done later.”
    • The fact is that most patients who fail brachytherapy do not fail because of disease still in the prostate, but because of cancer that was already outside of the prostate, just as is the case with most men that fail to be cured surgically.

Many of the experienced brachytherapy teams have done 1,000 or more implants over the past 10 years, and can readily be found if you use due diligence.

Take time to make your decision. Prostate cancer is indeed usually slow growing, and despite your immediate concern, devastation, and anxiety, making the right decision as to the treating team is paramount in helping you live as normal a life in the future as you do now.

Content on this page last reviewed and updated May 12, 2008.
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