Alex: Why do you think the medical community is still so stuck up on surgery, and we see
so much IMRT come through. I know it's kind of a money issue. Can you explain that?
Dr. Scholz: Prostate cancer, people really need to realize, is a business. It's a multi-billion
dollar business, and the people who are usually explaining it are also in the business of
doing one particular type of therapy, whether it's surgery or radiation. And the doctors
have naturally gravitated to the types of treatments that pay the best. So, seed implantation,
as things stand in 2019 is not nearly as well-paid as radiation therapy with IMRT, for example.
And so, doctors naturally gravitate to learn how to do the IMRT type treatment because
the reimbursement is so superior. There are discussions now to change that because the
clinical trials comparing outcomes with these different treatments, there's no ambiguity,
the cure rates are better with seed implants, and that fact is not lost on the different
regulators that decide how much Medicare is going to pay in, and so that's being looked
into very actively right now and I hope it is changed. The treatment with seeds is a
special skill and the doctors that haven't done it very much probably shouldn't be doing
it at all, and so you have a few doctors throughout the country that have maintained these skills,
and those are the ones, of course, that you would want to go to if need a seed implant.
But, oftentimes, seed implants may never get mentioned just because the people you're talking
to are either doing surgery or IMRT, and they use the reduction in the amount of seed implants
being done as an argument against it. "It's just not used that much" as an argument for
not doing it even though the studies clearly show that it's a better treatment. So, I think
the problem is, there are conflicts of interest, there are financial interests behind the scenes
that aren't talked about, and then there's just the momentum of the way people do stuff
sort of validates these methodologies and it just keeps chugging along. But, if they
do change the way payment is instituted, I think that we'll see a change in that.
Alex: Okay. Do you think there's anything that patients can do to help that process?
Dr. Scholz: Political activism is not my specialty, so I don't really know what the process would
be in terms of lobbying, but I think it's just a matter of patients being aware for
their own sake that seed implants do have higher cure rates and that the people that
are looking for the best outcomes should be looking into doing a seed implant if they
have a Teal type prostate cancer.
Alex: Alright. So, for seed implants, who do you trust? Who are the main people that
you go to?
Dr. Scholz: We've been working a lot with UCLA. We're going to have an interview with
Dr. Jeff Demanes who is an eminent seed implanter and he's going to provide us with a list of
names of experts that he feels are safe bets for centers around the country.
Alex: Oh, that's awesome. I'm looking forward to that.
So, I guess my last question when it comes to seeds and everything going on in the process
is: How do you, besides the PCRI, is there any other way that patients can really learn
about, you know, their different treatments and their different options? Should they be
talking, you know, in the future, should they go and talk to, you know, a seed expert? Should
they talk to a surgeon? Should they talk to all these multiple opinions and get them and
collect them and get multiple opinions all at once? You know, a lot of people are just
trusting what their doctors are saying, unfortunately.
Dr. Scholz: Well, I think going online—sometimes you hear that's a negative thing because there's
a lot of misinformation on the internet, but getting exposed to all the different options,
I think, is a valuable thing. And then, the next step is to probably talk to people in
support groups. There's enough exposure to the doctors in the community that way. Find
out who's had good results—which doctors are getting the good outcomes. And then, of
course, you have Helpline that can guide people as well. That's one of the tricky parts of
prostate cancer is once you decide on what to do is, who should do it? And that is not
a simple process because we don't have any real quality control in this business. It's
just a matter of word-of-mouth.
Alex: 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 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.