So, if I'm a patient walking into your office, and I've decided that brachytherapy is for
me, especially with HDR. What is the setup? Like, what is the type of conversation you
would have that you would like me to be aware of before I would have the procedure?
Well, we spend a long time talking to patients about the nature of the treatment, the nature
of their illness, the various treatment alternatives that are available to them. Particularly in
prostate, you have to go down the long list of internal and external radiation and surgery
and androgen suppression and so on and so forth, so those kinds of consulations are
actually quite long and detailed. And once I feel I've developed some rapport with the
patient—I feel like they understand—then we go on to after having reviewed their particular
case data set, make a decision with them about what makes sense, and some people want to
think about it, other people are ready to go and it's pretty straightforward HDR monotherapy,
or you have to use external beam and coordinate the care and hormones and so forth. So, it
takes a little bit of time to go through the process, and once you've made the decision—let's
say you've chosen, you have intermediate-risk group prostate cancer and you've chosen HDR
monotherapy—we make sure you're medically fit to undergo the anesthesia, which is spinal.
It's not particularly stressful. It's not brain surgery; it's not heart surgery—open
heart surgery—anything like that. It's transcutaneous and not very stressful, so patients from all
walks of life and degrees of health are potentially candidates for this outpatient procedure,
and we explain what you need to do in advance, the preoperative measures which are relatively
minimal, and then arrange for the patients once there's insurance authorization to come
in on two separate days a week apart and we do the implants, and then we follow the patients
after that. The patients do have a catheter inserted at the time under anesthesia and
that catheter is removed. That's true for any treatment of prostate cancer, but that
catheter is removed prior to the patients going home in 98% of the cases—95%, 98%
of the cases. So they go home and they have frequent urination and irritative things for
about two weeks and then lo and behold they get a whole lot better. Within a month, I
would say, 90%-95% of the patients are close to back to their baseline urinary status,
and there are some patients who do have more prolonged irritation, but if you wait it out
almost all of those get better without any intervention as well. So, it has a relatively
well-tolerated, low long-term risk profile and patients are pretty happy about it. That's
not to say that you have to select your patients properly. There are certain patients who maybe
have very large prostates who have problems that may need to have some kind of surgery
beforehand. They could potentially have a radical prostatectomy as an alternative. They
could have a transurethral partial removal of the prostate to open up the channel. There
are some circumstances where it might be better to take another approach, but I would say
of people who come to me for consultation, more than 90% of them are good candidates
for proceeding with the procedure.
So, if you would like more information about anything we talked about, you can go ahead
and contact our Helpline team and they will be available to talk to you. The number is
at our website, PCRI.ORG, and you can look up other information on prostate cancer treatments.
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