Reviewed by William Blahd on April 19, 2016
Sheldon Marks, MD Urologist; Male Infertility Specialist, Prostate Cancer Specialist, Microsurgical Vasectomy Reversal Specialist, Tucson, AZ.
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Sheldon Marks, MD: Radioactive seeds are an effective and very exciting therapy for men who are not candidates for surgery or don't want surgery. What that involves is taking tiny little rice-sized pellets, making them radioactive in a very controlled way so it's not wild radiation, it's very controlled, very specific and inserting them into the prostate under direct visualization through various techniques of ultrasound and CT scanning. So they know exactly where the seeds go, they put them right into the prostate, and they emit this radiation that kills the cells in that very specific area.
Sheldon Marks, MD (cont.): Like surgery, though, it's very operator-dependent. If you get a skilled radiation therapist he can place those seeds, you'll get dramatically great results. If on the other hand your doctor doesn't know what he or she is doing, or doesn't do it a lot then there can be gaps and areas where some of the cancer may not be killed. So it's as important that if you do opt for conservative therapies such as radioactive seeds, you still do your homework and find a doctor who knows what he or she is doing.
Interviewer: How does one find a doctor to do these sorts of treatments?
Sheldon Marks, MD: The frequency of the procedure is an important part, but it's not the whole picture. If the doctor does it a lot, then the chances are good that all things being equal, they're going to be better at it than someone who does it only occasionally. But still there's finesse, they have to know what they're doing. That's why it's the art and science of medicine. The science tells you what to do; the art tells you how to do it. It has to do also with judgment. You may be technically good but not have good judgment. You may not have a good fund of knowledge so you may do the right operation but for the wrong reasons.
Sheldon Marks, MD (cont.): So it's really a package. But definitely the frequency of the procedure is important. Heart surgeons, we know you have to do a certain number of heart operations a year in order to maintain that high level of skill and expertise. Many of these skills that doctors have to maintain— that surgeons are… vanish rapidly when they're not maintained. So you can't just do it two or three times a year and get the same results as an equivalent surgeon somewhere else that does it three or four times a week.
Interviewer: Um-hmm. And that applies to the placing of the radioactive seeds as well?
Sheldon Marks, MD: That applies to anything that involves technical skill, whether it's removing a skin lesion, plastic surgeons, heart surgery, prostate cancer, radioactive seeds. Even the finesse of the doctors that don't actually do seed placement, but calculate the dosing of the radiation. There's…there's an art to it. Some people just instinctively know what to do and have few complications and outstanding results. And there are other doctors that may be technically great but just something's missing and they have complications and patients don't do well.