Why isn't all prostate cancer treated with radioactive seeds?

Various types: There are different grades of prostate cancer making some cancers more or less aggressive than others. Staging of the cancer is also important. If a man has advanced cancer and is treated with radioactive seeds alone, the likelihood of failure is so high that it is not an good option. We try to tailor treatment to each patient to maximize the long-term cure with the lowest side effects possible.

It depends on risk: Brachytherapy with radioactive seeds or with high dose rate (hdr) brachytherapy can be used for low, intermediate, and high risk patients. Most people believe that seeds or hdr is most appropriate for low risk patients and that intermediate and high risk patients should be treated with a combination of brachytherapy and external beam radiation.

Majority should: There are many different specialist and interests as well as options in prostate cancer therapy. The lowest cost, equal effectiveness, one day treatment, lowest complications with incontinence and impotence leads to seeds or brachytherapy. Too many turf wars and people just making more money doing other things leads the patient to get conflicting advice.

Size; other diseases: Almost anyone with a gland size of 50 grams can have seeds placed to adequately deliver dose. Some larger glands are too big to cover (some can be shrunk with hormones). Prosca factors make it riskier in some, and some cannot stop blod thinners, have ulcerative colitis, or other medical relative contra-indicatons.

Not for everyone: Well planned and executed seed implants are highly effective for prostate cancer. But not all patients are candidates due to size of gland, extent of disease, and other factors. Also, if your urologist is part owner of a radiation facility, then financial incentives are against using seeds, and more patients are treated at the radiation facility.

Why should it be?: The 1st question in prostate cancer medicine is, should it be treated at all? If yes, then consensus is that all treatments are equal with respect to benefit. Variation occurs in toxicity based upon age, amount of pc, aggressiveness of pc, and the need to combine therapies. Suggest 2 opinions from different fields (medical oncology or urology or radiation) be obtained before deciding.