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How experienced are you?I have been a board certified practicing radiation oncologist for approximately 19
years. My expertise is in treating prostate cancer and I have treated approximately 4000 men with prostate cancer. I am considered
a pioneer in the field of prostate brachytherapy and co-developed the real-time technique for permanent seed implantation.
This technique is the most widely used technique in the world to perform prostate seed implantation. I have personally been
involved in teaching residents for 19 years as well as teaching physicians the real time technique of prostate seed implantation
in the United States, Europe and Asia. Meet Dr. Stock
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Should I consider Proton Beam radiation?
No. Proton Beam radiation is an outdated technology that first originated in the 1950s. Current studies show that it is
not only extremely costly and time consuming, but also much less effective than seed implants, with much greater side effects.
One study from the largest proton center in the country, at Loma Linda, in fact reported that the 5 year success rate with
proton therapy was only 73% (Slater, 2004). his is in comparison to our 95% success rates with seed implants (Terk, ASTRO 2009).
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Should I consider temporary high-dose rate radiation implants?
No. There are currently no results available beyond five years for this treatment, compared to 15 years from a prostate
seed implant. In addition, all men who have high-dose rate implants must have several weeks of external radiation AND multiple
implant procedures with anesthesia. At times, men may have the needles sticking out of their body for 24 hours while they
receive several radiation treatments. During this time period, the needles can cause significant discomfort, and move to potentially
harmful locations. In contrast, a prostate seed implant is a one-time only outpatient procedure that takes less than one hour.
There is no significant movement of the seeds once they have been implanted.
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Should I consider Cyberknife® treatment?Cyberknife® is one of many radiation
machines that can deliver conformal radiation therapy. In prostate treatment, it has primarily used to deliver y what is known
as hypo-fractionated radiation therapy. It delivers five very high doses per fraction treatments over two to three weeks instead
of more commonly used 45 daily fractions. The use of this hypo-fractionation must be considered unproven at this time. The
American Society of Radiation Therapy and Oncology (ASTRO)’s position on this type of treatment is that it deemed to
be experimental. The long term effectiveness and safety of this type therapy is not known and that is why ASTRO recommends
being treated with this type of therapy only on clinical trials.
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What about Cryotherapy?
Cryotherapy is when part of the prostate is frozen. While some believe this technology is improving, there are no major
studies available with results at more than 5 years. In addition, side effects such as impotence and incontinence are much
greater with cryotherapy than with seed implants, and in fact, are similar to more radical surgery. Most centers reserve cryotherapy
for the treatment of prior external radiation failures, and not for the up front treatment of newly diagnosed men. This procedure
should only be performed by experienced Urologists.
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Are all men with prostate cancer eligible for seed implants?
We believe that all men without evidence of metastasis (cancer spread to other organs) have a chance to be cured of their
cancer by a prostate seed implant and/or IGRT. We recommend that men diagnosed with prostate cancer consult with both a Urologist and our Radiation Oncologists.
Based on extensive data, we can tell you what your risk of having disease outside the prostate is. We will review your past
medical history and current physical condition and discuss the pros and cons of surgery, external radiation, and seed implants.
We have seed implant protocols to treat men with both early and advanced stage disease.
What is most important is that men take their time and feel comfortable with their decision. If a man chooses prostatectomy,
we suggest he have this performed by an experienced Urologist. If he chooses a seed implant, we recommend that our uniquely
experienced Radiation Oncologists treat him with the Procision™ Implant Technique.
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I’ve heard some people say that they do not think the PSA blood test is important for cancer screening. What do you think?
Both the American Cancer Society and the American Urological Association strongly feel that regular PSA blood tests and
physical exams lead to prostate cancer being diagnosed to an earlier, more treatable stage and, thus, can potentially save
lives.
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Do you participate in research on prostate cancer?
Yes. All patients treated are tracked in a computerized database. Their implants are all analyzed for quality, and
their results are carefully monitored. We participate in both local and national studies.
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How does radiation kill cancer cells?
Radiation can damage a cancer cell’s ability to multiply, ultimately leading to its death. Cancer cells are much more sensitive
to radiation damage than normal cells and are less likely to repair any damage done. They are thus selectively killed.
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Is it all right to give hormone blockers and radiation together?
Yes. Not only is it all right, research has shown that the combination can improve results in men with more advanced or
aggressive prostate cancers.
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Am I too young to be considered for Seed Implants? Contrary to the myth that young patients are better off
receiving treatment with surgery, young patients are ideally suited for treatment with brachytherapy. Since young patients
tend to have better sexual and urinary function prior to treatment, they are the ones that will benefit the most from brachytherapy
due to the treatment’s low side effect profile. In addition, since they will, on average, live longer than older patients,
they need a highly effective treatment. Long term data following brachytherapy demonstrates very high rates of cancer control.
In a paper that we published in 2010, we demonstrated that young men did as well as older men in terms of cancer control rates
at 10 years (Burri et al. Young men have equivalent biochemical outcomes compared with older men after treatment with brachytherapy
for prostate cancer. IJROBP 2010: 77; 1315.) In a recent paper that will soon be published in the journal Urology , we demonstrated
that young patients who were followed for a t least 10 years have excellent preservation of sexual function and very low incidences
of incontinence and rectal problems(Buckstein et al.)
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How long will I be out of work with a prostate seed implant?
Most men can return to work and their normal activities within 1-2 days.
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Since I have radioactive seeds in my prostate, am I at risk to other people?
No. The amount of radiation given off outside the body is negligible. In fact, the total exposure is equivalent to a single
trip on an airplane from New York to Los Angeles. For peace of mind, we recommend that you avoid close contact with pregnant
women and refrain from holding young children for 1-2 months afterwards.
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Am I at significant risk of other types of cancer after Seed Implant procedure?There is no good data that demonstrate
that brachytherapy increases the risk of secondary malignancies. Prostate brachytherapy involves the placement of radioactive
seeds directly into the prostate. The radiation emitted from the seeds has a relatively low energy and so the radiation produce
does not travel far beyond the prostate. This minimizes radiation dose to surrounding normal tissues and hence minimizes the
risk for secondary cancer formation. In one recent publication, investigators compared the risk of developing secondary cancer
after treatment with radical prostatectomy versus radioactive seed implantation. They found that there was no increased risk
of secondary cancers with the use of seed implant (Hinnen KA et al. Prostate brachytherapy and second primary cancer risk:
a competitive risk analysis. J Clin Oncol. 2011 Dec 1;29(34):4510-5. Epub 2011 Oct 24).
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Will I have to wear a urinary catheter after a seed implant?
Most men go home without a catheter and will not need one.
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Can I have surgery if the cancer re-grows in the prostate after radiation?
Yes, however, it is very unusual for cancer to re-grow in the treated area.
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What can I do if I was previously treated with proton radiation for prostate cancer and my cancer has recurred?
We are one of the few centers in the world experienced enough to provide prostate seed implants to men who recurred following
treatment with proton radiation or traditional external radiation. Our studies have shown that up to 2 out of 3 men can be
successfully treated in this manner. At the time of consultation, we can recommend some simple tests to help determine if
this is a safe and potentially effective option for you.
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How do I know if I was cured by a radical prostatectomy?
The answer is quite simple. A PSA blood test done two months after surgery should reflect a PSA < 0.2 If this is not
the case, you may have some cancer cells left behind that should be irradiated. In this circumstance, we may recommend IGRT
external radiation, as there is no prostate in which to accurately implant the seeds.
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Is there any hope if I am diagnosed with late/advanced stage prostate cancer that has already spread?
Yes. There are many promising hormonal and chemotherapeutic treatments on the horizon. Any member of our team will be happy
to discuss these with you and refer you to a medical oncologist for additional evaluation.
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What about HIFU (High intensity focused ultrasound) treatment?
Some men have been travelling abroad for this treatment due to questionable claims. A new European study published in 2008
showed that the 5 yr success rate was only 30% with HIFU (Misrai, 2008).
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What should I do now?If you have not been diagnosed with prostate cancer and are concerned that you may be
at risk or would like to be screened, you should consult your physician for a physical exam and PSA blood test. If
you have been diagnosed with prostate cancer you should contact Dr. Richard Stock at 212-772-2130
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