Frequently Asked Questions

If your questions are not answered here, please feel free to contact us. Our number is (714) 573-9500.

 

My doctor is recommending a radical prostatectomy or external beam radiation. I can see that the side effects are minimal with the seed implant procedure, but is the treatment as effective in eliminating the cancer?

The most recent clinical data, based on patients followed up to 10 years, shows the same percentage of implant patients remaining disease free as with either radical prostatectomy or external beam therapy. In addition, the side effects of impotence and incontinence are significantly less with seed implant treatment.

 

What is intraoperative treatment planning and why should I have it?

Intraoperative treatment planning uses a high speed computer in the operating room to electronically collect the ultrasound images and automatically calculate the treatment plan with little chance for human induced error. This revolutionary technology was pioneered by Dr. Doggett and is setting the standard for prostate brachytherapy technology. This technology is designed to dramatically increase precision of seed placement , to increase cure rates and decrease complication rates. The system is a platform for technology soon to be introduced including real time virtual needle guidance systems and robotic needle and seed placement systems.

 

I've heard that radioactive iodine implants were tried many years ago and proved ineffective. Is that true?

That is not accurate today. Radioactive seed implants were first experimented with in the 1940's. From 1965 until 1983, many hospitals nationwide performed seed implants. In those days, however, the implants were performed using an "open" implantation method, which involves surgery to expose the prostate gland. In addition, the open method required the physician to feel the prostate gland with his fingers to determine where to place the seeds -- an extremely imprecise method. Poor placement of the seeds meant there were areas where the seeds were too far apart and not enough radiation was delivered.

Today, the guesswork is gone. Ultrasound template guidence was invented in the late 1970's in Denmark to distribute the seeds in a uniform fashion through the prostate, thus eliminating the need for a surgical incision and eliminating the guesswork associated with the freehand technique.

 

Is this treatment experimental or investigational and will my HMO/insurance company pay for it?

Seed implants are not experimental nor investigational by any criteria. All insurance companies and HMO's are required to provide coverage for seed implants to their members as it is a covered benefit under Medicare.

 

I have an HMO and they want to send me to a seed implant doctor who doesn't have much experience. How do I get an appointment with Dr. Doggett?

Call our office for an information packet and then request in writing an authorization from your primary doctor to see Dr. Doggett.

 

I've heard that prostate cancer is so slow growing that some doctors recommend no treatment, especially surgery. Why should I consider treating it at all, and why specifically with seed implants?

True, some patients may not need treatment because their cancer is growing so slowly. On the other hand, prostate cancer is the second most common cause of cancer death in men. In addition, there is no foolproof way to detect how aggressive a cancer will be in any specific patient. Because seed implants generally have significantly fewer side effects, early treatment of the cancer using this method may be an excellent choice for many men -- even when other treatments are rejected.

 

Is the radiation from the seeds a danger to my family?

No. The radiation from the seeds is of such low intensity that people around you are in no danger whatsoever.

 

Can I pass radioactive seeds through sexual activity?

No. The seeds are imbedded in the prostate gland and are not likely to be passed to another person through sexual activity. You should use a condom for the first act of intercourse after seeding.

 

How long does the radiation last, and what happens to the seeds in the prostate gland?

The radiation is present in the prostate for approximately 2 to 6 months. After the radiation disappears, the seeds remain in the prostate gland permanently, causing no problems.

 

What kind of radioactive seeds are there?

Radioactive palladium seeds and radioactive iodine seeds are the two current choices. Both give an equivalent chance for cure. Dr. Doggett uses palladium for his patients because the side effects for palladium are much less than for iodine.

 

Will I need external beam radiation in addition to the seeds?

You may need a short course of external radiation two months after the seeds only if your Gleason score is higher than 6 or if your PSA score is over 10. Dr. Doggett's use of advanced technology has eliminated the need for external radiation in many cases. Higher Gleason and PSA numbers mean there may be some extension of cancer cells through the covering of the prostate gland and giving the external beam radiation is designed to eliminate these cancer cells. The short course of radiation is given to a small area of the pelvis so side effects are quite small.

 

What about proton therapy?

Protons have not been shown to be any more effective or lower in side effects than standard IMRT external beam radiation. The ICER sudy indicates that the comparative value of brachytherapy is higher than for IMRT and the comparative value for proton therapy is lower than for IMRT.

 

What about HIFU?

High intensity focused ultrasound is a new technology for treating prostate cancer. It is 2-4 hour procedure done under spinal or general anesthesia. It has not been approved by the FDA as of August 2010. Studies have shown 15 to 23% of patients will show biopsy proof of cancer after HIFU treatment and an up to 7% incontinency rate. {Crouzet, et al. Eur Urol. 2010 Jul 3 and BJU Int. 2006 Dec;98(6):1193-8 Ficarra, et al}

 

What about Cryosurgery?

Cryosurgery involves freezing of the prostate gland under anesthesia to destroy cancer cells. Biopsy proves recurrence after cryotherapy ranges from 14.5% to 38%. Incontinence rate is 4.8% and only 25% of patients could have intercourse after cryosurgery. {J. Urol.2008 Aug; 180(2):554-8. Jones et. Al. Cleveland Clinic}

 

What advantage is there to robotic prostatectomy over open prostatectomy?

Robotic prostatectomy has somewhat less blood loss than standard open prostatectomy and a somewhat shorter hospital stay. Return to work time is not radically shortened by the use of the robot over standard open prostatectomy. The overall potency and continence rates were 73.6% and 87.1%, respectively with the robotic approach . Studies have not shown the rate of complications occurring with robotic prostatectomy to be substantially different from those seen with open prostatectomy. Rates of impotence and incontinence are higher with surgery of any type compared to brachytherapy. {Arch Esp Urol. 2007 Sep;60(7):755-65. Martinez-Salamance }{ Expert Rev Anticancer Ther. Singh, et al 2010 May;10(5):671-82}

 

What options do I have if the brachytherapy does not work?

The chance of the brachytherapy failing in the prostate is very small,1% or less. If this small risk of failure should occur, a second seed implant is possible and has been done successfully and safely. Salvage cryosurgery or salvage prostatectomy is also possible, but all forms of salvage therapy need to be performed by highly experienced practitioners.