Brian J. Moran MD, Medical Director of Chicago Prostate Cancer Center, has been performing brachytherapy procedures to treat prostate cancer since 1990, with over 15,000 brachytherapy treatments to date. In that 27+ years, he has placed a high value in the effectiveness of brachytherapy due to the cure rate and level of patient satisfaction with the procedure. “When I first started with brachytherapy, the critics would contend that there was not enough follow-up in 5 years,” he stated. “Now, there is 20-year data that shows this treatment has outcomes the same as surgery or external beam radiation. And the outcomes can actually be considered much better when you factor in the quality of life issues.”
But the doctor still sees a struggle in getting fellow physicians to adopt the treatment. “In the past, 95% of my business came from referrals sent by other physicians,” he shared. “Now that figure has dropped to around 20%. Unfortunately, much of the medical environment does not offer brachytherapy, because doctors tend to offer the treatment that they are trained in, or, if you own a radiation center, that’s where you are likely to refer patients to.”
But Dr. Moran is still very busy performing this effective treatment, due to patient demand for brachytherapy. “With physician referrals down to only 20%, our remaining 80% of new patients are referred by other former patients, or they come to us on their own,” he explained. “The majority of patients receiving brachytherapy are self-motivated to pursue it. Many baby boomers are finding us on their own, as they are better consumers of healthcare in that they make use of the data that is available.” In addition, many men don’t want to spend upwards of 8 weeks with external beam radiation treatment or risk erectile dysfunction, which may occur with surgery. Furthermore, the available data is strong, showing the effectiveness of brachytherapy in combination with other treatments.
Focal brachytherapy: Same results with even fewer side effects
But even more recent data is demonstrating the strength of brachytherapy in treating prostate cancer on its own and in much more targeted amounts than what was previously thought necessary. Known as focal brachytherapy, this technique does not saturate the whole prostate with radiation. The number of seeds are limited to focus energy on one side of the prostate containing the area of cancer.
Dr. Moran’s team recently completed a focal brachytherapy study that they plan to publish shortly. The study, containing 50 patients, had a success rate of over 90%, comparable to other treatments. But with less radiation, the incidence of side effects drops significantly.
“The results of our study are very encouraging,” stated Dr. Moran. “Focal brachytherapy is a quality medium between watchful waiting and more aggressive treatments. The latest data demonstrates that using focal therapy with properly selected patients is as effective as a prostatectomy, external beam radiation, or a full gland prostate implant. And by using fewer seeds, you are not putting the gland at risk and are reducing the risk of complications.”
Brachytherapy adoption increasing worldwide, but challenges remain
Dr. Moran has completed seed implant proctoring programs in Hong Kong, Korea and most of Europe. The physician lectures and provides brachytherapy training abroad. He recently trained a large group of physicians from Japan to visit the Chicago Prostate Cancer Center and received an invitation to lecture on the procedure in Tokyo. He has also found that the procedure is very popular in Canada due to their publicly funded healthcare system. Prostate brachytherapy offers a lower cost treatment, with equal cure rates, and fewer side effects than other cancer treatments.
But in the U.S., Dr. Moran is concerned that brachytherapy could become a lost art. “We need to keep training younger physicians in this procedure, but without referrals, there is a risk of interest by the doctors evaporating. A recent study showed that 80% of training programs do less than 12 of these procedures a year. That’s clearly inadequate. But there is hope in the fact that patients are now coming to us on their own.”
“It makes perfect sense that these patients have such a high interest in the procedure,” he continued. “Once we sit down with a patient and review the pros/cons of the treatment options, most will look at us and ask why would we do any other procedure? That’s the conclusion that a well-informed patient ubiquitously makes. Also consider that the total length of the procedure is 3 hours of physician time, including seeing the patient, physics planning, and the procedure itself. It’s very time efficient for both the provider and the patient. If you’re a candidate for seeds, it’s clearly the best option. And the majority of patients are suitable candidates.”
Where brachytherapy is heading
In terms of the future of this treatment, Dr. Moran believes that we are at a crossroads. “As we head down the road of value-based medicine, we find that brachytherapy has outcomes and patient satisfaction that are second to none,” he explained. “There is no hospitalization, an infection rate that is essentially zero, and side effects for sexual function, bladder function, bowel function are at their lowest. It has enormous value. If healthcare shifts to a model where consumers have a greater say in their own care, then demand for brachytherapy will go way up. I think we’re starting to see this shift. I believe that of all the prostate cancer treatments poised for the future, brachytherapy is absolutely in the driver’s seat.”
Brian J. Moran, M.D.
- Medical Director of Chicago Prostate Cancer Center
- Graduate of Loyola Stritch School of Medicine, where he also completed his residency
- Board-certified by the American Board of Radiology
- Member of the American Society of Therapeutic Radiology and Oncology, the American College of Radiology and the American Brachytherapy Society
- Performed thousands of prostate seed implants and has proctored physicians in the United States, Korea, Europe and Hong Kong
- Frequent speaker at professional meetings, and has authored numerous publications in medical journals and textbooks