CMH offers new prostate cancer treatment

Brachytherapy proves effective option for some

Brachytherapy for prostate cancer is administered using "seeds," small radioactive rods implanted directly into the tumor.

Prince Frederick, MD (March 25, 2008) - About one third of local men diagnosed with early stage prostate cancer could benefit from a new treatment option now being offered at Calvert Memorial Hospital. Clinical studies show the minimally invasive procedure - called brachytherapy - compares favorably with conventional alternatives with few side effects.

"It's one of the better treatment options for localized prostate cancer," said board-certified urologist Dr. Shafquat Meraj. "It's safe and effective." Localized means the cancer has not spread to the lymph nodes or another area.

The procedure involves inserting tiny radioactive seeds through hollow needles directly into the tumor in the prostate gland to shrink it and eventually destroy it. In recent years, Meraj said more men have been choosing this method over surgery (that removes the prostate) because it has a lower rate of impotence and incontinence.

Meraj performed the first brachytherapy in December at CMH with board-certified radiation oncologist Dr. Boris Naydich. Since then they have performed four more. Meraj estimates that he personally sees 100 - 200 cases of prostate cancer per year and that 25 - 30 could be treated with brachytherapy. Board-certified urologist Dr. Modesto Rivera is also certified to perform the procedure.

"The technique is very popular and is producing positive results," said Naydich. "With localized cancer, the cure rate is better than 90 percent." In the last eight years, he has performed 300 similar procedures in Southern Maryland as a primary treatment for localized disease and as a boost for high-risk prostate cancer patients. Of that number, five patients experienced a recurrence of their cancer. The treatment outcomes are comparable to results from intensity modulation radiation therapy (IMRT), which consists of daily treatments over a period of nine weeks.

According to Meraj, brachytherapy offers other advantages. "It can be done as an outpatient procedure," he said, "and the recovery is much faster. The patient is back on their feet the next day." With traditional surgery, the patient could expect to be hospitalized several days.

The procedure produces relatively small risk of serious complications. In general, these patients have mild-to-moderate frequency and discomfort at urination and some rectal complaints, which are successfully managed with medication. More prolonged issues are uncommon and are seen in about five percent of patients.

Brachytherapy takes 90 minutes compared to two to three hours for traditional surgery and can be done using regional or general anesthesia. Working in concert, the team determines in advance the radiation dosage and the exact number of seeds required for a case, as well as the precise seed placement to effectively treat the tumor.

"Overall, the side effects are reasonable and tolerable," said Naydich. "Most urinary and bowel problems are temporary."

Brachytherapy is not for everyone, he said. Generally, the best candidates are men who might otherwise expect to live at least 10 more years and whose cancer is confined to the prostate, or older men who are not eligible for surgery.

"Previously, local patients had to travel an hour or more to have the procedure," said Meraj. "Now, we're able to offer it here at CMH. This benefits our patients because they can be treated by the same doctor ... and there is continuity with the follow-up care."

He said there has been an increase in the number of prostate cancers diagnosed locally. "We're actively looking for it more," said Meraj, "so we're finding it more and finding it earlier." Since 2005, 512 men have been treated for prostate cancer at CMH.

The hospital's community wellness program offers free prostate cancer screenings several times throughout the year. The next screening is planned for March 28 and 29 from 8:30 a.m. - noon at the Calvert County Health Fair at the Calvert Pines Senior Center in Prince Frederick. Pre-registration is required. To make an appointment, call 410-535-8233.

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