Prostate Brachytherapy
A Blessing in Disguise
When Hank Ebbeling was diagnosed with prostate cancer in 2011, he talked to friends who had dealt with the disease and had undergone a procedure called brachytherapy. Meanwhile, his wife Beverly did research online and liked what she read about the minimally invasive outpatient procedure.
They were referred to Peter F. Orio III, DO, MS a radiation oncologist at Dana-Farber/Brigham and Women’s Cancer Center at Milford Regional Medical Center (DF/BWCC) who is renowned nationwide for his extensive presentations, research and training on brachytherapy. Since Dr. Orio’s name came up quite a bit in their research, the couple knew Hank was in good hands.
Performed in the Surgical Day Center at Milford Regional Medical Center, brachytherapy is a highly effective, minimally invasive treatment that targets low dose rate radiation to the cancerous location in the prostate, shrinking tumors and killing cancer cells. This treatment involves implanting radioactive seeds directly into the prostate. “It’s a niche of radiation oncology with about seven hundred doctors performing it across the country,” notes Dr. Orio. “When you think of less than a thousand physicians providing this service for the entire country, you can appreciate why it is not offered everywhere.”
Other technologies that treat prostate cancer include radical prostatectomy, an operation to remove the prostate gland; external beam radiation therapy, which involves sending radiation from many directions over a period of weeks; and hormone therapy. “Patients need to know there are multiple treatment options for prostate cancer,” emphasizes Dr. Orio. “It’s possible a man will receive treatment without knowing all of his options, which includes brachytherapy. After they are diagnosed by their urologist, men should really ask to be seen by a radiation oncologist as well. Within the Milford Regional healthcare system, you have these options. Knowledge is power.”
Since there are so few doctors who perform brachytherapy, Dr. Orio says that it’s important for these specialists to cover a wide geographic area and reach as many patients as possible. Having offered the procedure at Milford Regional Medical Center since 2011, Hank was one of Dr. Orio’s first local patients and, looking back, is a great example of a success story seven years later. However, Hank’s story had a twist… when he went for pre-operative testing back in 2011, it showed that Hank had an even bigger problem to deal with than prostate cancer. “They found a spot on my lung the size of a golf ball,” recalls Hank, now 78, a Whitinsville resident and former longtime smoker. “Prostate cancer saved my life.”
Since Hank was diagnosed with stage-three lung cancer, and the prostate cancer was still considered low risk, Dr. Orio said the lung was their first priority. Within two weeks, Hank was having lung cancer surgery at Milford Regional. He also underwent chemotherapy and radiation at DFBWCC. Ironically, Dr. Orio was part of the medical team treating Hank’s lung cancer as his radiation oncologist.
“It's a crazy thing to say, but we're so thankful he had prostate cancer,” says Beverly. “Without that, he might not be here now. We feel we had the best doctors and the whole staff was amazing. It's a miracle how it all worked out and how he’s okay now. It was such a blessing being able to get treated in Milford, or else we would’ve had to go to Worcester or Boston.”
Over the next few years, Hank got his strength back and had his PSA levels carefully monitored, taking a watchful waiting approach. Although prostate cancer is slow growing, Dr. Orio explains that the cancer can expand beyond the prostate and can find its way into the bones, so it’s important to be monitored. With Hank’s PSA levels rising, and his pathology demonstrating more aggressive disease in his prostate, it was finally time to undergo treatment. Hank chose to proceed with brachytherapy.
According to Dr. Orio, brachytherapy can be used by itself for low and intermediate risk stages of prostate cancer, and performed in conjunction with other treatments for those with high risk disease. Typically, Dr. Orio performs brachytherapy on men in their late forties up to the mid-seventies. “I implant a lot of younger men as it preserves erectile function when compared to other treatments and has very little risk of incontinence as we’re not altering the man’s anatomy,” he states.
However, since brachytherapy requires the patient to undergo anesthesia, he does not recommend it for someone who has less than ten years of life expectancy based upon other health issues. In those cases, Dr. Orio feels other therapy options may be more appropriate. “With external beam radiation therapy, for example, the patient doesn’t have to go under anesthesia,” says Dr. Orio.
During the brachytherapy procedure, Dr. Orio explains that a “super computer” quickly devises 500,000 unique treatment plans for the physician to review and subsequently select and tailor the best possible plan for the patient. This process allows the physician to pinpoint where the radioactive seeds should be placed in the prostate and the possible needle-seed combinations. The computer program then distills down the information and highlights the best plan for that particular patient’s anatomy and cancer. The medical team evaluates the recommendations, and once the plan is finalized, the care team has a blueprint to deliver the radioactive seeds into the prostate via guidance by 3D ultrasound.
“We link the seeds together so they are placed in the needle in the configuration we want,” Dr. Orio relates. “We go in through the perineum. We put a needle in, take it out, and leave the seeds behind, repeating this about 12-14 times. We know where the needle needs to be and we take care to put it exactly where it should go. We can also go three-five millimeters past the prostate, which we’ll do for higher-risk disease, to stay a step ahead of the cancer.”
Dr. Orio notes that he performs the procedure alongside a physicist who oversees the calibrations to make sure the equipment is working properly and checks the radiation doses; a dosimetrist who links the seeds together; and a urologist (usually the patient’s) who will help insert the seeds. The brachytherapy procedure takes about 60-90 minutes to complete.
“There’s no cutting and no blood loss,” Dr. Orio says. “A bigger needle is used for a blood draw than to put the seeds in. The patients go to recovery, wake up and are usually out of the hospital an hour and a half later. The next day, they’re back on their feet, recovered and hard-pressed to know we did anything. The elegance of the procedure is its simplicity.”
Today–seven years after his lung surgery and four years after brachytherapy–Hank says his PSA levels are almost nothing. Even though he doesn’t need to, Hank continues to check in with Dr. Orio once a year.
“He's a great doctor, very knowledgeable, easy to understand and friendly,” he says. “I was so thankful I had a top-notch doctor. The hospital treated me real well through everything. In a way it was a good experience for something that was bad. Between Milford Regional, Dana-Farber and Brigham across the street, and all three of them working together, it made it easier for my family. All my care was in one place. I’m so thankful.”
To schedule an appointment with Peter F. Orio, III, DO, at Dana-Farber/Brigham and Women’s Cancer Center at Milford Regional Medical Center, call 508-488-3800.
