BY RICHARD LAM, MD
Intermediate risk cancers are cancers that tend to grow, but not advanced or not metastatic.
Their characteristics of intermediate risk prostate cancer, they tend to be Gleasons 7, PSA levels are between 10-20, when one does a 12-core biopsy there’s more cores involved (4-6 cores of cancer), and oftentimes a clinician will feel a nodule. On ultrasound or MRI, we will see a lesion near the capsule, but not breaking through the capsule.
So with this type of prostate cancer, people need treatment.
Traditionally, intermediate risk cancers were treated either surgery or radiation. Seeds was not considered an option. But in 2016, a good study retrospectively done, where they compared seeds + radiation (which is pretty potent treatment) versus seeds by itself. Very interesting data came out – the study showed patients who did seeds only did just as well as the patients who did the combination of seeds + radiation for intermediate grade.
For higher risk patients, we would still do a combination treatment. For patients that are intermediate risk prostate cancer who doesn’t have severe urinary side effects already, I would definitely recommend seeds by itself.
Seeds can be done permanently, where they place the radioactive pellets within the prostate and usually they place anywhere between 50-90 seeds into the prostate. Another way of doing seeds is a temporary high dose seeds – placing filaments into the prostate and then removed. Usually the radiation oncologist places between 10-15 filaments (the difference here is the seeds are temporary).