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Daniel Petereit, MD, The New Approach to HDR Brachytherapy at Monument Health

Jun 22, 2021 07:00AM ● By Med Magazine

Radiation Oncologist Daniel Petereit, MD, and his team recently performed South Dakota’s first high-dose-rate (HDR) prostate brachytherapy treatments using real-time, ultrasound-based planning. The Monument Health Cancer Care Institute is currently the only site in South Dakota offering this type of comprehensive prostate brachytherapy, both HDR and low-dose-rate (LDR) for men with various stages of prostate cancer. We spoke with Dr. Petereit about his decision to begin offering HDR prostate brachytherapy again after a 15 year hiatus. 

MED: You have continued to offer LDR (low dose rate) permanent seed implants for men with less aggressive prostate cancer, but why did you stop offering HDR brachytherapy? 

DP: Fifteen years ago, we had to admit the patients to the hospital for one or two nights. They would have an epidural. Then they would have to have three or four separate treatments. It just got to be too labor intensive. The reason we have gone back to this is that now we have the technology and equipment and up to ten years of data that we can do it all in three hours and with fewer side effects. 

MED: How does the new HDR brachytherapy system differ from what you were doing before?

DP: The technology is such that we don't need to admit them or get a CT scan on them or even move them out of position to do both the planning and the treatment. With the patient asleep, we place the catheter into the prostate. We use a very sophisticated ultrasound-based planning system that generates an immediate radiation plan so that we can optimize dose distribution. We treat them and take everything out and they go home. This treatment offers high chances for a cure with less risk for both short and long term urinary side effects. 

MED: You are a recent past president of the American Brachytherapy Society. Why do you think more sites are not offering prostate brachytherapy?

DP: The biggest problem is that residents are not seeing enough volume to get sufficient experience doing this. We launched a national initiative about two years ago designed to help get residents up to speed so they can do more brachytherapy, not only for prostate cancer but for gynecological cancer, too. I think another problem is that too many patients do not have the opportunity to consult with a radiation oncologist before they make a treatment decision. 

MED: Why do you think it is important that men in our region have this as an option? 

DP: We have very solid evidence to suggest that one of the treatments with a high chance for cure is a combination of daily radiation therapy with a brachytherapy boost. When men don't have access to quality brachytherapy they lose one of the most effective treatment options. They also lose one of the most convenient and cost-effective treatment options. 

Note: The HDR brachytherapy approach being offered at Monument Health is for patients with curable, but more advanced prostate cancer.  Patients undergo four to five weeks of daily radiation before they receive an HDR implant. This is also used as a treatment for patients who recur after external beam radiation.