Mike Carlson

Yogi Berra, a famous New York Yankees baseball player, once said, "When you come to a fork in the road, take it." And while Mike Carlson always enjoyed this ambiguous quote, he never thought it would have epochal meaning for his life.

Carlson, a chaplain at Luther Midelfort Hospital
-- part of Mayo Health System, was diagnosed with prostate cancer in the fall of 1998. His father died of prostate cancer, and so regular screening — via the prostate-specific antigen (PSA) blood test and digital rectal exam — had become part of Carlson's routine health visits. When his PSA level tested above 4.0, the benchmark threshold number for his age group, further testing revealed he had early-stage prostate cancer.

As his urologist presented the treatment options, Mike felt he definitely had come to a fork in the road. A standard course of surgical treatment — radical prostatectomy — had implications for urinary incontinence, as well as sexuality. If other options failed, such as external beam radiation, they would render future treatments difficult and less effective. Taking a "wait and see" approach could severely limit his future choices — and his life.

Mike and his wife suddenly realized what Yogi Berra meant; the fork in life's road was before them and they needed to choose their path quickly. Once they started down the chosen course, there was no turning back, as many treatments permanently negated other choices.

Charting the course

As a chaplain, Mike recalled a time he had visited with a patient who had prostate cancer. The man mentioned brachytherapy during their conversation, but Mike didn't understand exactly what it was. Now very intrigued and personally affected, he did extensive research and decided this type of therapy might be a viable treatment option for him, given his age and stage of cancer.

"Brachytherapy involves implanting tiny low-dose radioisotope seeds (Iodine 125 or Palladium 103) directly into and around the prostate," says Brian Davis, M.D., a radiation oncologist with Mayo Clinic in Rochester. Davis was part of the multidisciplinary team that administered Carlson's brachytherapy, along with Torrence Wilson, M.D., Carlson's urologist.

The seeds release low-energy X-rays and fight the cancer at the exact point of the disease. An article in The Journal of Urology (May 2003) cited prostate brachytherapy as the ultimate three-dimensional (3-D) conformal therapy, permitting doses far exceeding other forms of radiation treatment. Continued refinement in brachytherapy has improved outcomes, while limiting rates of urinary, bowel and sexual dysfunction.

"Brachytherapy seemed like the best treatment choice for me, given my age and desired outcomes," says Carlson. "After thoroughly discussing all the options with my doctor and making a decision about which treatment modality I wanted to pursue, I was anxious to get through it."

Planting the seeds, reaping a cure

Once planted during brachytherapy, the I-125 seeds used in Carlson's treatment emitted a low-energy photon to fight his cancer directly at the affected site. The seeds are actually rice-sized titanium cylinders, which have the radioactive substance sealed within them.

"The seeds are accurately placed into and around the prostate via needle insertion through the perineum (between the scrotum and rectum) precisely guided by transrectal ultrasound," explains Dr. Davis. The procedure involves a multispecialist team approach, involving urologists, radiation oncologists and allied health science professionals.

Brachytherapy is a minimally invasive procedure that is relatively painless and performed under spinal or general anesthesia. The entire treatment is completed in one to two hours with little recovery time. Usually patients return home the same day or the next day.

"Since 1990, Mayo Clinic has been treating early-stage prostate cancer with brachytherapy," including more than five years in Rochester, notes Dr. Davis. "In the past 13 years, more than 1,500 patients have been treated with seed implantation across Mayo Clinic."

Nationally, over 30,000 men have brachytherapy each year and it has become a major treatment modality for early-stage prostate cancer. The American Cancer Society and other health organizations recognize it as an effective treatment and the procedure is reimbursable by all major insurance companies, including Medicare.

It has been five years since Mike's seed implantation. "My PSA level doesn't register and there are no other signs of cancer," he says. "I've had minimal side effects, I'm enjoying all aspects of life and remain physically active. Though it was an uphill battle, I still hit the downhill slopes on a regular basis," says Carlson, an avid skier. "There is some anxiety about living with cancer, but I encourage all men to get regular checkups. If you are diagnosed with any disorder or disease, explore your treatment options through trusted sources and networking. Then, talk with your doctor about treatments, options and side effects. Get personal and open up about your fears, anxieties and quality of life. Then, choose the course that's right for you."