Dr. Ron Benoit with the University of Pittsburgh Medical Center is a bit of a maverick. While most urologists lean towards prostatectomy when dealing with a majority of prostate cancer cases, this physician favors brachytherapy—and for good reason.
This physician breaks away from convention, as he estimates that 60% of urologists recommend surgery when treating prostate cancer, with 25-30% recommending external beam radiation and only 10-15% relying on brachytherapy. This is in contrast to the fact that brachytherapy has very successful outcomes without the severe impact of negative side effects.
“In the University of Pittsburgh Department of Urology, we have probably 35 urologists in our department, and I’m the only one who does brachytherapy,” explained Dr. Benoit. “But I think the long term data pretty clearly demonstrates that the cure rate with brachytherapy is equivalent to surgery.”
Defining the treatment mindset
“Surgeons and urologists tend to be the first to diagnose prostate cancer,” said Dr. Benoit. “They’re seeing patients first, they want to help patients, they’re trained to operate, so that’s where they go. They feel very strongly that they help patients with surgery, so they offer surgery.”
“But I think the problem is that the complication rate is not taken properly into account,” he continued. “I’m a surgeon myself and I think we all tend to downplay the rate of complications. A surgeon may quote a complication rate from a major academic center that specializes in radical prostatectomy. That center can have a very low rate of a particular complication, but their complication rate is not representative of the risk to the patient in a community setting.”
How to change the current mindset
Dr. Benoit is hopeful that attitudes on the effectiveness of brachytherapy are starting to shift. He cites the fact that as more patients learn the hard data available on the treatment, the more they are requesting to explore it as an option in fighting their own cancer. “As the 15 and 20-year data on modern brachytherapy showing outcomes that are equivalent to surgery, I think minds will begin to change” he said.
Dr. Benoit feels that beyond patients, there is another powerful change agent at play shifting the focus towards brachytherapy. “I really think that the big motivator is going to be financial,” he stated. “We need to lower healthcare costs in this country. When payers are told about the benefits of brachytherapy and realize that treatment costs are much lower than surgery and external beam radiation, and the outcomes are just as good if not better in terms of both cancer control and side effects, that’s when the needle will move in terms of a big change. I think it’s the payers who are going to start pushing providers to do brachytherapy, or explain why they’re not.”
“The logic also simply makes more sense from a value-based care perspective,” he continued. “If you can cure a patient with a lower risk of a complications, why wouldn’t you do it? I think that’s going to spread awareness of the data quicker than just urologists talking about it on their own.”
Cesium-131 Isotope for Brachytherapy
Dr. Benoit has been performing brachytherapy treatments for over 20 years, since starting his practice in 1996. At the time, he found that while prostate brachytherapy with Iodine-125 and Palladium-103 was effective, it offered patients a quick return to full activity. But patients had very bothersome urinary side effects with Iodine-125 and Palladium-103, which took an average of 12-18 months to subside.
“We were approached about using Cesium-131, and we were hoping the half-life, energy level, and dose rate of this isotope would reduce the duration of the side effects,” stated Dr. Benoit. “We wanted to push the envelope and try to change things for the better, so we decided to start using Cesium. We followed those patients very closely for urinary symptoms, bowel symptoms, and we performed extensive follow-up testing. The majority of our patients were indeed very close to their baseline, if not back to their baseline, 3 to 6 months after the procedure.”
Dr. Benoit works with Sushil Beriwal, MD and Ryan P. Smith, MD at University of Pittsburgh, to maintain one of the largest databases in the world for patients treated with brachytherapy utilizing the Cesium-131 isotope. Currently, the database is tracking the results for approximately 630 patients who have up to ten years of follow-up. They recently published the 5 year PSA outcomes of over 300 patients. Using the Phoenix criteria, the 5-year actuarial BFD was:
- 96.0% for patients in the low-risk category
- 92.7% for patients in the intermediate-risk category
- 82.9% for patients in the high-risk category
Based on their success to date, Drs. Benoit, Smith and Beriwal are launching a focal prostate brachytherapy treatment program using Cesium-131, enrolling 11 patients so far. “I think that’s an exciting new frontier for the treatment of prostate cancer, and certainly for brachytherapy,” he said. “We’re realizing that we can provide even more targeted treatments, reducing the overall amount of radiation, yet still realize the same outcomes. This means the future treatment will hold the promise of even less side effects, made possible through Cesium-based, targeted brachytherapy.”
If you or a loved one has recently been diagnosed with prostate cancer and want to know about all of your available treatment options, including brachytherapy, please contact firstname.lastname@example.org
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Ronald M. Benoit, MD
- Urologist with sub-specialties in Urologic Oncology and Urological Surgery
- Practicing at the University of Pittsburgh School of Medicine
- Board certification from the American Board of Urology
- MD from the University of Pittsburgh School of Medicine
- Residency at the University of Maryland School of Medicine
The University of Pittsburgh School of Medicine (UPMC)
- Operates more than 25 academic, community, and specialty hospitals, 600 doctors’ offices and outpatient sites, employs 3,600 physicians, and offers an array of rehabilitation, retirement, and long-term care facilities
- Largest non-governmental employer in Pennsylvania, with 65,000 employees
- The first nonprofit health system to fully adopt Sarbanes-Oxley.
- Ranked No. 12 in the nation on the U.S. News & World Report Honor Roll of America’s Best Hospitals – with 15 adult specialties ranked