Study shows prostate brachytherapy using ‘Radioactive Seeds’ is an effective alterantive to surgery or external radiation

Radiation oncologists and urologists at The Cleveland Clinic have performed their 1,000th prostate brachytherapy, a type of treatment in which radioactive seeds are implanted in the prostate to destroy cancerous cells. A new seven-year study shows outcomes from this minimally invasive procedure are statistically similar to outcomes from either radical prostatectomy or external beam radiation.

The Cleveland Clinic’s 1,000th prostate brachytherapy patient was Edwin Brugger, a 61-year-old construction worker from Oak Harbor, Ohio. Mr. Brugger was diagnosed with an enlarged prostate in September 2002. In January 2004, he learned he had early stage prostate cancer. Mr. Brugger came to The Cleveland Clinic for a second opinion convinced that surgery would be required to remove his cancerous prostate. Instead, physicians told him that prostate brachytherapy was an alternative option for him because of the early stage of his disease.

“We were so satisfied with the care I received at the Clinic,” said Mr. Brugger, who underwent prostate brachytherapy April 12. “So far, I haven’t experienced any measurable side effects or problems, and I’ve been able to work three to four hours a day.” Mr. Brugger returns to the Clinic for a follow-up examination in a month.

The Cleveland Clinic began offering prostate brachytherapy in September 1996. The program has since grown to become one of the largest in the country. Prostate brachytherapy is a minimally invasive procedure during which radioactive seeds (iodine 125) are permanently implanted into the prostate.

The number and placement of these seeds are determined by a computer-generated treatment plan. Typically, about 100 seeds are implanted. The seeds remain in place permanently, but become biologically inert after about 10 months. Prostate brachytherapy allows a high dose of radiation to be delivered to the prostate with limited damage to surrounding tissues.

“The seeds implanted truly are seeds of hope for many men with prostate cancer,” said Jay Ciezki, M.D., a radiation oncologist at the Clinic. “This treatment helps to minimize the radiation exposure of healthy tissues and allows men to return to their daily routines more quickly, usually within 24-48 hours.”

Prostate brachytherapy is used most frequently to treat men with early stage prostate cancer. Other factors, such as tumor size, previous prostate surgeries and tumor stage, also must be considered prior to this procedure.

According to the new research, published in the April edition of Radiotherapy and Oncology, men treated with this procedure, radical prostatectomy or external beam radiation all had statistically similar outcomes. The study involved 1,800 early stage prostate cancer patients, including 1,178 patients enrolled at The Cleveland Clinic. It represented one of the largest head-to-head comparisons of the three treatments ever conducted.

“One of the strengths of The Cleveland Clinic’s prostate cancer program is the number of patients who participate in clinical trials to help further scientific knowledge,” said Eric Klein, M.D., section head of urologic oncology at the Clinic. “Since the inception of the Clinic’s prostate brachytherapy program, 28.3 percent of all patients treated have enrolled in clinical trials.”

Of those patients, 75 percent of them were enrolled in trials initiated by Cleveland Clinic investigators.

“This is noteworthy because cancer centers are rated according to the proportion of patients participating in investigator-initiated clinical trials,” Dr. Klein said. “Nationally, about 20,000 cancer patients are treated within clinical trials. We appreciate the participation of our patients. Each person’s information has the potential to help countless others.”

Mr. Brugger is among the Clinic’s patients who have chosen to enroll in a clinical trial. He is taking part in an ongoing study examining how the quality of life for men with early stage prostate cancer is affected after treatment with brachytherapy, 3-D conformal external radiation or prostatectomy. Eric Klein, M.D., is the principal investigator for this trial for The Cleveland Clinic.

Prostate cancer is the second leading cause of cancer death among men in the United States. An estimated 230,110 new cases of prostate cancers will be diagnosed in 2004, according the American Cancer Society. Likewise, the disease will claim the lives of more than 29,900 men in the United States this, the society estimates.

The Clinic’s prostate brachytherapy program is a joint collaboration between the Department of Radiation Oncology and the Glickman Urological Institute.

The Cleveland Clinic website address is www.clevelandclinic.org.