By Dr. Bernard W. Taylor
Texas Oncology – Longview Cancer Center
The American Cancer Society’s 2022 Cancer Facts and Figures report estimates that nearly 270,000 men will be diagnosed with prostate cancer this year. This represents nearly 50% more than the number of men diagnosed annually in the years just prior to the pandemic. 1 in 8 men in the US will be diagnosed with prostate cancer in their lifetime. It is the second leading cancer diagnosis among men and the second leading cause of death from cancer. By the age of 80, at least 50% of men will have been diagnosed with prostate cancer.
These sobering statistics are not unfamiliar to you as clinicians who treat prostate cancer. But they are staggering for newly diagnosed patients and their loved ones learning about their disease and looking for answers.
I was asked to share my thoughts with all of you because I’m passionate about brachytherapy and I have experience with the available choices. My preference is reflected here and a big reason behind that includes not only the experience with the array of choices, but for a very personal reason. I am a prostate cancer survivor who has personally experienced the long-term symptoms that you do not have with Cesium-131. I also speak as a physician, who has seen its benefits for the many patients I have treated. I have performed over 4000 cases to date.
When I was diagnosed, I went through many of the same feelings about mortality, treatment, and long-term side effects. I had many people give me “advice” even though I was an oncologist and was an expert in prostate cancer. But they wanted to “help”. What I understood was that I needed to just breathe, learn, and think. I had low risk prostate cancer, so I knew I had time. I also had treated many patients who had been through prostate cancer treatment and knew firsthand what their long-term side effects were. After some thought and research, I chose LDR Brachytherapy. I chose this technique as I felt it had the highest cure rate with the least short term and long-term side effects. I also knew it would not be a big interruption in my life as this was a one-day outpatient procedure.
I researched who was the best since I could not perform this procedure on myself! I found someone I trusted and had this procedure done on April 10, 2012 and was back at the office on April 12, 2012. Everything went well and I have been blessed with very little side effects. My PSA has been less than .3 ng/ml over the last 9 years.
But let me also share with you that at the time, I was offered surgery as I was 52 years old. I was told I was too young for radiation therapy. More in a moment about LDR brachytherapy and choices, but part of my story is what I was told wasn’t accurate. This is not a consideration in LDR brachytherapy. I have treated patients in their 40’s with great success. And I am also stopping here to add to that because many patients are also told if they have radiation, they can’t have surgery later. That is true, but what they are not told is that surgery fails locally 30% of the time while LDR brachytherapy fails locally 1%, so only 1% of patients would not be a candidate for salvage surgery. This is not a reason to rule out other options besides surgery. I have seen other patients who rushed into surgery and then discovered they had other options including LDR Brachytherapy.
Returning to your considerations, I hope my experience will be helpful. I’ve used Iodine- 125, Palladium-103 and Cesium-131. Candidly, it took me a while to move to Cesium-131 because I was comfortable as a physician with my protocol, but I noticed that I was managing a lot of urinary symptoms. So, I looked at Cesium-131. I had heard about it from other docs and once I tried Cesium-131, I found there was an advantage in less urinary symptoms, which I found unique. The other unique factor is the planning process. It wasn’t any more difficult. So, it didn’t really change my process at all. This is a good aspect because it was an easy switch.
As a clinician, I want you to know that I think Cesium-131 offers the right energy level to take care of cancer. The shortened half-life means side effects are less and the energy means delivering the dose faster, which I believe better cures the cancer. We may never prove that clinically, but I believe it is better and it is certainly better for high-risk patients. Consider what it means when you add the fact that they are not going to have the long-term urinary side effects they would have with Iodine-125, which is 6 to 9 months or the long side effects with palladium and so they will recover faster than they would with other sources.
I understand that there is always a fear to change your protocol as a physician when you are comfortable with an established approach. But you shouldn’t be fearful to change to Cesium-131 because of the advantages that I see clinically and because as I already told you, I learned firsthand that using Cesium-131 really didn’t change my process at all.