A 75-year-old prostate cancer patient
shares his non-surgical treatment experience
“I felt nothing. After waking up, I was in a recovery room.
There was no blood, but I was a little dizzy from general anesthesia.”
Thomas L. Payne, a 75-year-old American expatriate living in Thailand for over 25 years, decided to treat his prostate cancer with a temporary radioisotope brachytherapy at MedPark Hospital. After the treatment, there are no remaining radioisotopes in his body. He is satisfied with the outcome and wishes to share his experience through a Patient Story for others to follow.
His journey began in the early 1990s when he relocated from the United States to Thailand to oversee human resource management for Kimberly-Clark, a transnational corporation. His responsibilities included managing healthcare benefits for expatriate employees, which led to his familiarity with many renowned physicians. Thomas enjoyed good health and had no reason to be concerned until he discovered he had cancer.
“Four years ago, I returned to the States to treat my melanoma skin cancer in Chicago. Doctors removed the cancerous mole while I was under general anesthesia. However, that day, I had a severe adverse reaction to the medication and was rushed to an emergency room late at night. Unfortunately, they misdiagnosed me, causing my bladder to overdistend, resulting in kidney failure.”
Elevated PSA: High Risk of Prostate Cancer
Mr. Thomas stayed in the United States for recovery. Nearing the return date, he received medical advice from a close friend who is a urologist. The friend advised him to seek treatment with Dr Paibul Boonyapanichskul at MedPark Hospital.
“My friends unequivocally vouched for the renowned expertise of Dr Paibul in the field of urology. When I met him, I was thoroughly impressed. Dr Paibul patiently addressed all my questions and closely monitored my condition. Eventually, he detected significantly elevated PSA levels in my blood. Consequently, he recommended an MRI, PET/CT Scan, and a biopsy to assess the risk and make a diagnosis of prostate cancer.”
After a thorough examination, the doctor discovered a lesion within the prostate gland, showing a tendency to progress. Therefore, the doctor laid out various treatment options for prostate cancer, including the temporary insertion of radioactive seeds. This method was unfamiliar to Mr. Thomas since few medical professionals in Thailand could perform the procedure.
Transient radioactive seed insertion: a fast, non-surgical treatment for prostate cancer with quick recovery
“Dr Paibul recommended a form of radiation treatment called brachytherapy available in the Light of Day Radiation Oncology department. The types of equipment for this procedure are all big-ticket items, and I was unsure how many hospitals in Thailand have access to this advanced technology. Fortunately, MedPark Hospital was well-equipped, and I was fortunate to have Dr Yongyut, an experienced radiotherapy specialist, overseeing my care. I sincerely thank my friends for introducing me to these two exceptional doctors. I am in good hands here.”
Dr Yongyut Kongthanarat and his team played a pivotal role in this treatment, which began in June and concluded in July, involving four transient radioactive seed insertions. Mr. Thomas expressed initial concerns about the adverse effects of anesthesia, so to ensure his safety and well-being, the medical team conducted various anesthetic drug tests and closely monitored his condition overnight before commencing the treatment.
“Dr Paibul employed small needles guided by the MRI images fused with images from a dedicated ultrasound machine for the seed insertions. Surprisingly, I did not experience any pain during the procedure. After waking up, I found myself in a recovery room with no signs of bleeding, just a slight grogginess from the anesthesia.”
Following each treatment session, Mr. Thomas could resume regular eating routines. Dr Paibul recommended regular exercise and assured him he could continue his daily activities without interruptions.
That all cancers are curable is not too far-fetched.
His medical friends regularly provide Mr. Thomas with notable updates, particularly concerning medical knowledge, technological advancement, and research achievements. These developments lead to more effective treatment strategies and gradually bring the statement 'Cancer is curable' closer to reality.
“Cancer treatment advancements are progressing rapidly. There is a wealth of research and numerous new treatment options available. Previously, the cancer survival rate was said to be 50-50, but now many say it is 99%. One of my friends has been conducting cancer research for over 30 years. He founded the Queen Sirikit Center for Breast Cancer, and even at 77, he continues his work. The past five years have seen significant strides in treatment, and we are almost on the verge of curing all types of cancer, which is why he cannot retire.”
“Do you know that Dr Paibul and Dr Yongyut are seniors as well, I can feel the immense strength they possess. They have saved many lives. I admire people dedicated to doing good for the world, regardless of age. I have great respect for them.”
Mr. Thomas implores all men to undergo regular prostate screenings to ensure early detection and timely intervention, which is instrumental to achieving the best outcomes.
“I would like to emphasize to all men the importance of getting an annual prostate cancer screening, starting as early as 45 or 50 years of age. Regular PSA tests can help detect any abnormalities early on, like in my case. My PSA level, initially below 1, increased to 1.3 and then jumped to 5.6. This PSA rise breached the threshold for my prostate cancer diagnosis and instigated prompt treatment.”
Men should be aware annual prostate cancer screening is crucial.
Prostate cancer is a common disease in men worldwide, with an incidence of approximately 7.7 per 100,000 individuals. More than 1,000 men lose their lives to this disease each year in Thailand. One of the factors contributing to prostate cancer is genetics. Dr Paibul Boonyapanichskul, a urologist, recommends an annual PSA test to assess the risk of this disease.
“If someone in the family has the BRCA2 gene or if your father or grandfather has had prostate cancer, there is a chance that the younger generation may be at risk. For individuals in this group who are 40 and above, it is advisable to have an annual PSA test. As for the general population, screening should begin at 50. Even a PSA level below 4 does not guarantee the absence of cancer. However, if it reaches 4, the risk increases, and one should undergo an MRI and tissue biopsy to be certain.”
For Mr. Thomas, initially, Dr Paibul provided laser treatment for his enlarged prostate with substantial improvement in his quality of life. However, after several years of monitoring, it was evident that his prostate-specific antigen (PSA) levels had risen. Subsequent MRI scans revealed a relatively aggressive form of prostate cancer. Dr Paibul recommended treatment options, including surgery, radiation therapy, or temporary radioactive seed insertion. This new technique significantly minimizes damage to surrounding normal tissue.
Advantages of radioactive seed implantation for prostate cancer treatment
Dr Paibul is certified in LDR brachytherapy by the Seattle Prostate Institute and has introduced this method for treating prostate cancer via radioactive seed implantation. He is one of the first physicians in Thailand to perform this procedure. Low Dose Rate (LDR) brachytherapy involves the placement of tiny radioactive seeds permanently within the prostate, gradually emitting low-dose radiation over a lifetime. Patients retain these radioactive seeds, and there could be minimal exposure to close contact. This emission of radiation persists indefinitely without extinction over time.
Nowadays, a new technique called High Dose Rate Brachytherapy (HDR Brachytherapy) involves temporary radioactive seeds without leaving any permanently within the body. Radioactive sources are inserted through tiny needles into the prostate and emit a high dose of radiation for a brief period, typically a few minutes, before being removed. This treatment requires multiple sessions, but the advantage is that patients do not retain any radioactive sources within their bodies, minimizing long-term radiation exposure.
“Surgery requires a lengthy recovery period of more than a month and approximately three months for the bladder and urethra to heal and regain their normal function. However, HDR brachytherapy uses only slim needles to direct the radiation source into the prostate. After each treatment, there are no lingering radioactive sources in the body. Patients can resume their normal activities immediately after leaving the hospital, including sexual activity. This is one of the significant advantages,” emphasized Dr Paibul.
Furthermore, surgery can significantly impact patient quality of life. It may lead to urinary incontinence, requiring several months of treatment and avoiding strenuous activities. Additionally, sexual activity should be abstained for approximately 2-3 months. Statistically, the chance of regaining pre-surgery sexual function is only around 50%.
Dr Yongyut Kongthanarat, a radiation oncologist, explained the intricacy of the procedure and some lesser-known advantages:
“We insert very slim needles into the prostate, guided by ultrasound, typically utilizing 15-20 of these extremely tiny needles, with a diameter of less than 1 millimeter. The radioactive material then runs into each of these needles, irradiating the prostate based on computer calculations. The radioactive material remains within the patient for only a very short time, approximately 5 minutes, and then withdrawn from the body.”
“Following the procedure, the patient rests in the recovery room for about two hours. There are no visible scars, and it poses no harm to nearby vital organs. Patients can return home by car or by plane for long-distance travel. The following day, they can resume their normal life activity, including sexual function.”
What makes the treatment successful, besides advanced technology and sophisticated software, is the efficient team behind it. Dr Yongyut emphasized:
“Besides Dr Paibul and myself leading the treatment team, we have physicians, board-certified anesthesiologists, physicists, radiographers, nurse specialists, and others working together. They have had excellent training and collaboration to ensure effective patient care. This treatment modality requires a large and skillful team. There are very few hospitals in Thailand that have this capability. Anyone interested can contact the hospital. I am confident that HDR Brachytherapy at MedPark is a great option for prostate cancer patients.”
