No-surgery prostate procedure hailed as potential cure Radioactive iodine "seeds" are implanted in cancerous prostate.

May 29, 1991|By Sue Miller | Sue Miller,Evening Sun Staff

At 70, David T. Lewis had no serious symptoms of prostate cancer. But his doctor thought a blood test to check the level of his PSA, or prostate specific antigen, was in order.

A shocked Lewis then discovered his PSA was 26 -- in "the serious range." That's how he came to be the University of Maryland Medical Center's third patient to undergo a new non-surgical procedure for early prostate cancer in older men that is being hailed as a potential cure.

The technique, first introduced on the East Coast by UM a year ago, uses 7-inch-long needles, a grid and rectal ultrasound to implant radioactive iodine "seeds" in the prostate, a male sex gland.

"In the first six of our 11 patients -- all without spread of cancer to other sites -- we're getting at least a 30 percent reduction in the tumor and the prostate," which becomes enlarged, Dr. Stephen C. Jacobs, an oncology professor who heads UM's urology division, said yesterday.

"We hope that means we've killed all the cancer and turned everything else into a scar. The regression continues beyond six months to12 months," Jacobs said.

He said it is too early to determine tumor shrinkage in the other five patients who have had the procedure within the last three months.

"I came out of it without any significant side effects whatsoever," said Lewis, retired head of the sociology department at the University of Maryland Baltimore County.

"I feel at the moment that I am clean," Lewis said. "My PSA has gone from 26, which is a level of concern, to 3. In another six months, a biopsy will establish if the cancer is still there."

Lewis, who had the procedure last October, was lucky. Forty to 50 percent of newly diagnosed prostate cancer patients already have disease that has spread to other organs. Yesterday, Lewis urged all men approaching 50 to take the blood test that reveals an elevated PSA or cancer.

In the new treatment, once a patient undergoes anesthesia, the needles are used to insert between 42 and 70 tiny radioactive seeds directly into the prostate. The number is based on the size of the tumor.

A specially designed grid guides the needles and a trans-rectal ultrasound, or imaging machine, is used to show exactly where the seeds are being placed.

The seeds are as thin as pencil leads and about a quarter of an inch long. They are placed one to 1 1/2 centimeters apart.

"The seeds are made of steel and what's important is what's inside -- radioactive iodine or Iodine 125," said Dr. Pradip P. Amin, assistantprofessor of oncology.

Jacobs described it as the "treatment of choice" for men 65 or older who cannot undergo major surgery and with cancer confined to the prostate.

Prostate cancer strikes one in every 11 men and if a man lives to be 90, he will have prostate cancer, Jacobs said. It is the second leading cause of cancer death in men after lung cancer.

Up to 12,000 American men could benefit from the new technique, the doctors estimated. It is being used in four centers in the country, including Atlanta and Philadelphia. A private doctors' group in Seattle has treated the most patients -- about 300 -- with "very encouraging" results, Jacobs said.

What leads Jacobs and Amin to think this procedure will lead to higher survival rates and possibly a cure is that it allows the radioactive seeds to be placed more precisely throughout the prostate and higher doses of radiation to be administered directly at the site of the tumor,while not harming surrounding healthy tissue.

According to Amin, the procedure also "offers a second chance to men whose tumors have grown back after they were treated with external beam radiation therapy," which affects the whole pelvic area and causes such side effects as diarrhea, burning during urination and fatigue.

Previously, no alternative treatments for a possible cure were available, Amin said.

About 85 percent of men treated with surgically implanted radioactive seeds survive at least five years, the doctors said.

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