An Opinion

The State of Brachytherapy Training Today - the Weekend Wonder

In my estimation the training received today by various Urologists and Radiation Oncologists is a national disgrace. This dissertation is about Brachytherapy training but the problem is universal for prostate cancer in the various treatments modalities that we use.

If you have an MD degree and want to learn how to do seed implants, it is an easy simple manner. It takes a couple days of your time (and a little cash). "Yesterday I couldn't spell Brachytherapy and today I are one?" must be their slogan.

Lets look at what the urologists does in his training to do surgery. He attends medical school and is supervised by board certified Urology Professors while they perform multiple radical prostatectomy operations. When they have been evaluated by the senior doctors as being proficient they are allowed to complete their education. Even then some patients hesitate to get surgery from a brand new grad.

In the case of Radiation Oncologists they go through a training program to treat prostate cancer with radiation and seeds are a part of the field of radiation.

None of this is true in the preparation of a doctor to do a seed implant. He can makes a reservation for a class that starts frequently under Dr. Blasko in Seattle (and others), plucks down his grand or so, arrives ready to spend a couple days or so of training and observing a procedure or two hopefully live but might be video tape. I have been told he is never allowed to touch a patient. Then he is given his graduation papers and becomes a Brachytherapist. Is there any on site evaluation of the procedures that he does on poor unsuspecting patients. No! None! We probably spend more time training someone to do CPR. The good doctor probably will do his first procedure when he returns home - it may have already been scheduled.

When I was at the 1999 AUA (American Urological Association) convention I picked up a brochure that said they would make any member a "Center of Excellence" in Brachytherapy in their own community in six weeks time. First most of the six weeks are done in getting all the hardware together and getting the approvals. Once that has been shipped and installed they will go through a training program with docs that will be shipped in to train them. How many will they do, I have no idea but whatever - it will not be enough to adequately train them. At least these doctors get some direct supervision for a couple procedures or so. A quantum leap above the Blasko training procedures but inadequate anyway you look at it.

To the docs who use this type of training I have referred to them as "Weekend Wonders". The matter of this poor training is a matter of life and death to men out there. You see men who are having some adverse side effects, I suspect that most of these men have been treated by doctors who have done few procedures, none supervised and inadequate training. They get their money you get the morbidities. A seed implant procedure can be done, and done well, in about 30 minutes or a little more by a true artist and he obtains a full coverage of the gland.

I define a Center of Excellence as one that has performed a procedure and at the same time has kept comprehensive records and have reported in peer reviewed medical journals the results of their treatments. They must have documented proof, in the terms of published peer reviewed studies, of their total history of every procedure done in their institution. There is no other way that we, as patients, have any knowledge of their successes of failures. In virtually every case these Weekend Wonders will never publish and you never will be able to measure their results.

Who is hurt by this - you and I the patients. It is because we have been taught that we are not to challenge the doctors and to follow their advice. We are not informed about the "old boys" network among docs who refer patients back and for the between them based many times on friendships and not on medical skills or up to date procedures.

All I can say is that kind of training of docs in Brachytherapy is unacceptable to me and I will continue to protest wherever I can. It ought to be stopped and the doctors who participate in it are not adequately trained and we, the patients, will suffer. That is why I have made a big deal out of going only to a Center Of Excellence for your therapy - any kind.

The only way that this inadequate training will be stopped is if we simply ask our doctors a few simple questions.

1. Where was your formal training to be a Brachytherapist?

2. How long of a training program was it?

3. Was it associated with a University or private clinic?

4. How many procedures did you actually do while in training?

5. How many of your first procedures were actually done under the observation of a senior Brachytherapists?

6. How long have you been doing seed implants?

7. How many have you personally implanted yourself?

8. Have you published your results.

When a doctor cannot answer the above to you personal satisfaction - you walk out of the office. It is the money (or lack thereof) to the graduate, that will change the training programs.

Sure there are exception to everything - but this can be a guideline.