Anyone have experience with this technique? A friend just had a consult with a research /oncologist (a Dr. Song) at Johns Hopkins and is being offered a spot in a study where they will
Implant seeds in a very limited area to address what is now a very small area of cancer( Gleason 3+3
Grade 2A) with the hope of stopping the cancer very early on….. He’s on the fence about it with leanings toward doing it……any thoughts,feelings,opinions,experience? Information needed to render an opinion?
If the results were from a 12 needle biopsy, I would do Barchy on the whole prostate.
If results from MRI, I would consider it, but PCa cells are not always confined to one area.
thanks for the opinion…results currently are from 2 separate 12 needle biopsies but prior to acceptance into the study he will have, I believe,pet scan.
The nice thing about active surveillance (AS) is that it requires no therapy. In the longest-running AS trial in North America, 55% of low-risk men (like your friend) have had no progression in 20 years of follow-up so far. It makes no sense to me to have a therapy, like focal brachytherapy, when your friend will continue to be on AS for many years, possibly for his entire life, whether he has the treatment or not.
He will have to be on AS because PCa is a multifocal disease in about 90% of patients. Biopsies usually miss the microscopic bits of cancer. So he will still require periodic mpMRI and targeted biopsies, whether he gets the therapy or not. What has he gained?
I agree with you.
I would not do it. Better for him to continue AS as you say.
I am just curious, if you implant seeds could you still have mpMRI?
Seeds are mostly iodine or palladium covered in titanium - not ferromagnetic, so MRI is not a problem.
That is good to know. Thanks
I thought it was always focused by its very nature. You plant the seeds where they need to go and not where they don't?
But then I got mine in conjunction with IMRT radiation.
I agree with Tall_Allen.
Personal note: I consulted with Dr. Song on several occasions (I had been impressed with what I had read and heard about him). I found him rude, arrogant, condescending and WRONG about my condition. Specifically, I had a 7:30am apt. He encountered me in the waiting area (we were the only two people there); he did not even acknowledge my presence (I was 2 ft from him). He was late to the apt by 30 mins. He had a resident (one of the down sides to Hopkins is that it is a teaching hospital) see me first. He guy did not introduce himself nor his interpreter (the resident was severely hard of hearing). Nor did anyone ask my permission to have him present at the consult. King Song arrived. We reviewed my history and status; treatment had not yet begun. He asked me about my HIV status. I became angry - I don't have HIV. My anger stemmed from his not knowing my history not from his assuming I had HIV. He also got other details of my history wrong. He responded to my questions but offered little else: no empathy; no support/guidance; little detail on what the treatment involved (btw, he said 2 yrs of ADT; other docs said 6-9 mos); and so on. It was one of the worse doc apts I've ever had. Oh, and, btw, the resident did a DRE and totally missed where my prostate was (made me laugh). I wrote to the uro who I had been seeing me for 7 yrs of AS suggesting he not refer anyone to Song. I also wrote to Song. Never heard a word from him. Not surprising.
Good luck to you and your friend. I suggest he get other opinions.
EdinBaltimore
Lol. I met Dr. Song as well and came away with the exact same impression.
HDR Brachytherapy after initial RT 
HDR boost Brachytherapy + IMRT
Chemo treatment/What happens after chemo? 
HDR Brachytherapy after the 20 fractions?
Need input on ADT, Brachytherapy, etc.
