So you mentioned seed therapy and I'd like to kind of get into that. So we have temporary
seeds and we have permanent seeds. Which one—which would you use in each category?
So, what are called temporary seeds, they put a high energy seed through a straw that's
put temporarily into the prostate and do a slow pull back with that high-energy seed
and it radiates the prostate. They're called temporary because all the apparatus is removed
when you're done and you don't walk out with any radiation in you. All of the radiation
is complete.
And how long does that process take?
It's just a day visit to the hospital and sometimes you'll have to do it a week—repeat
it a week later. The permanent seeds are a one-time implantation of seeds that slowly
burn down over about a 15-30 period and then they just remain inert metal afterward. So,
there are a lot more similarities than differences in terms of cure rates. There's never been
a head-to-head trial showing that one approach is better than the other. The way that I think
of them is mostly in terms of convenience and also in terms of the seriousness of the
cancer. One advantage that the temporary seed approach has is that they're able to go outside
and around the edge of the prostate more easily. So, for high-grade cancers, Azures, Gleason
8, 9, and 10, that have larger tumors, the high-dose-rate seeds are easier to get a bigger
margin or to treat the seminal vesicles. The advantage of the permanent seeds is simplicity.
They can be put into the body with a 45 minute outpatient procedure. People can walk out
and go have dinner with their wife after the treatment and it's a much less involved process.
Not being in the hospital overnight or even on two separate occasions, as is the case
with the temporary seeds. But other than those caveats, there's no reason to think with a
standard Teal type case that one is more necessary than the other or more effective than the
other, and therefore, a lot of people go with the permanent seeds. The permanent seeds tend
to be more popular just because they're more convenient.
Are there any issues leaving metal in the prostate over time?
Well, in the old days, people became nervous about the seeds migrating outside of the prostate,
floating around the body (not that it was particularly dangerous, but it sounds terrible)
but they've developed newer technologies where they string the seeds together so that that
problem hasn't been an issue. The metal can be detected sometimes on metal detectors just
like a pacemaker or something like that, but it doesn't really present a problem once it's
explained.
And is there really a difference in the side effects between the two?
No, so the side effects are pretty much identical. They, with any type of radiation or seed implant,
there's a risk of erectile dysfunction and then there's gonna be a risk of some urinary
issues. Usually, those blow over pretty quickly.
Okay, so in the future, for future treatments that the patient may need, would temporary
seeds versus permanent seeds, is there more issues with permanent where if since there's
still metal in the prostate, they can't have this type of treatment, or temporary?
Well, that's a good question because the surgeons, to this day even though it's an outdated issue,
are talking about what to do if radiation doesn't control the disease. It used to be
a big problem because the radiation therapies were suboptimal and cancer would come back
in the prostate. That's very, very rare with modern, well-performed seed implants, but,
God forbid, that rare situation arises, no, there's no real difficulty. There's so many
different ways to treat the prostate now with cryotherapy or high-intensity focused ultrasound
or other types of salvage procedures, laser, that we practically never talk about using
salvage surgery anymore even if someone does need salvage, there's so many better ways
to approach it.
If you have questions about anything that we've talked about today when it comes to
seeds, our helpline can definitely assist you with that. So you can go ahead and head
to our website, PCRI.ORG, and under "our services" you'll see helpline, and you can submit your
question in email form or give us a phone call. We're here for you and it's honestly
an honor to do it. So, thank you so much, Dr. Scholz, for just answering our questions
once again. Again, if you would like to submit a question that you would like Dr. Scholz
to answer, you can go ahead and put that in the comment box of this video, and we really
appreciate your time, and we hope you have a great week.