Prostate Cancer Issues
Frequently Asked Questions about Permanent Radioactive
Seed Implants for Prostate Cancer
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Main FAQ Page
Prostate Cancer Issues
Logistics of a Permanent Implant
Side Effects of a Permanent Implant
Potency after a Permanent Implant
Radiation Safety after Permanent Implant
Pros and Cons of Implants
Follow-up after a Permanent Implant
What parameters, Stage, PSA, Gleason score or other, should a patient
have in order to be a candidate for seed implantation?
In general, men with organ confined disease are candidates for permanent
seed implantation. The probability of organ confined disease is related
to the clinical stage, PSA and Gleason score. In general we prefer patients
who have a clinical stage of T1 or T2, a PSA less 10 ng/ml and a Gleason
score of 6 or less. Patients who have a higher risk of disease outside the
gland (extra-capsular extension) will do poorly after an implant alone and
should either be treated with combined 3D-conformal radiation therapy and
implant or 3D-conformal radiation therapy alone. Some men will have an unusually
large gland, unusual anatomy or a large TURP (transurethral revection of
prostate) defect, all of which may make the implant technically more difficult.
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PSA as a staging tool: Partin's tables
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PSA as a staging tool: Partin's tables (continued)
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Do you recommend a bone scan?
Generally, no. As you see in the accompanying figure, a bone scan is
rarely positive with PSA values less than 10 ng/ml.
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PSA and the probability of a positive bone scan.
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Why do some patients receive external beam radiation in addition to
seed implantation?
A permanent seed implant is based on the supposition that the cancer
is only in the prostate. For many patients this is the most likely scenario.
The range of radiation from seeds is only 5 mm.
However, we know from early implant series that patients who have a higher
risk of disease outside the gland had an inferior cure rate with implant
alone and for that reason would benefit from the external beam radiation.
Patients with a high risk of disease outside the gland generally receive
a short course of external beam radiation (5 weeks) duration prior to permanent
seed implantation, in this case the seeds act as a boost.
What is the Thomas Jefferson implant consulting process?
We prefer that a patient be seen at the multi-disciplinary program conducted
at the Bodine Center for Cancer Treatment at Thomas Jefferson University.
This program has radiation oncologists, urologic oncologists, medical oncologists
and pathologists. Patients with prostate cancer have a number of treatment
options and we prefer that the patient be presented with those options before
selecting a particular therapy. Every patient's pathology is reviewed, and
many times we find discrepancies in the outside reports. The multi-disciplinary
program team meets on Wednesday once a week at the Bodine Center for Cancer
Treatment. Patients are asked to bring their pathology report, pathology
slides and results of any testing done (PSA, bone scan, CT scan etc.). Having
the opportunity to ask questions of the respective specialists in a single
setting is something our patients have found useful in making an informed
decision.
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