Transition concerns should not stop you from adding Cesium to your prostate brachytherapy practice. With a thoughtful approach to planning and the right support, you can seamlessly upgrade your prostate brachytherapy to the power of Cesium.

Photo courtesy of Texas Oncology

Dr. Bernard Taylor has practiced brachytherapy for the treatment of prostate cancer since 1996 including more than 2000 cases. He is also a prostate cancer survivor who chose brachytherapy for his treatment. A long time user of Iodine-125 for monotherapy and Palladium-103 for combination therapy, Dr. Taylor has transitioned to Cesium-131 as his isotope of choice in 100 percent of his cases.

He recently shared with us the origins of his interest in Cesium-131, how he addressed transition concerns, early results and practical benefits of transitioning isotopes.

Stepping out of the comfort zone into a superior source

“We watched Cesium’s market entry and early data for prostate cancer treatment, but our patients and our practice were doing very well with Iodine and Palladium,” Dr. Taylor says. “We were happy where we were and delayed our transition until the market matured and more data became available.”

Growing evidence of efficacy due to Cesium’s short half-life and higher energy compared to Iodine and Palladium hit the sweet spot and convinced Dr. Taylor to make the change.

“We have previously reported that Cesium-131 leads to quicker recovery of voiding function, with return to clinical baseline by 3 months and statistical baseline by 6 months post-treatment. Our current findings strengthen this body of literature by demonstrating that patients treated with the Cesium-131 isotope are able to maintain this baseline quality of life in the long term.” – Dr. Ronald Benoit

Dose rate, planning and cost

“Initially we were concerned about rectal dose and dose rate,” Dr. Taylor says. “Can we get good coverage and be careful with the rectum? We were comfortable where we were with Iodine and Palladium including pre-planning. But the outcomes data and patient experiences our colleagues shared with us convinced us it was time to make the transition to Cesium.”

Dr. Taylor advises colleagues interested in transitioning to Cesium to be prepared to make adjustments in planning. Enlist experienced Cesium users to fine tune planning adjustments including very close attention to placement.

“We visited with Dr. Brad Prestidge who educated us on his pre-planning methods and observed several cases with Dr. Steve Kurtzman who uses a similar implant process to ours,” Dr. Taylor says. “Putting eyes on a case with a clinician whose planning methods are similar to ours generated a nearly instant comfort level with the transition to Cesium.”

Because of Cesium’s higher energy fewer seeds are required. As such, Dr. Taylor believes the cost of the Cesium ‘seed package’ per case is closely equivalent to Iodine.

The supplier’s role in a smooth, seamless transition

Because Isoray studied Dr. Taylor’s team’s case management and procedural processes up front, the practice required zero changes to their ordering and logistics process.

“Isoray’s team quickly addressed initial difficulties with packaging and made the process of transitioning isotopes seamless,” Dr. Taylor says. “That’s part of their job and one they do exceedingly well. You don’t want to change a lot if you can help it. Most of what we do, with the exception of planning, hasn’t changed.”

Results

“Told they might be worse in the short-term, our patients’ acute side effects are about the same and diminish significantly and much more quickly with Cesium, usually after one month,” Dr. Taylor says. “This is not the case with Iodine and Palladium, which extend the burden of their negative effects – including urinary bother – much longer than is necessary given Cesium’s availability and efficacy for prostate cancer treatment.

“I understand my fellow clinicians’ anxiety related to switching radiation sources, especially those who have been practicing good brachytherapy with other isotopes for years if not decades” he says. “But Cesium provides everything we want for prostate brachytherapy as both a monotherapy and in combination therapy, including delivery of a high dose of radiation more quickly for high risk patients in a low dose rate ‘setting.’”

Dr. Bernard W. Taylor, MD

  • Longest tenured radiation oncologist, Texas Oncology (1993)
  • American Society of Therapeutic Radiation Oncology
  • American College of Radiation Oncology
  • American College of Radiology
  • American Brachytherapy Society
  • Texas Medical Association

Disclosures: Proctor for Bard in the past. Proctor for Isoray. No other disclosures.