Treating Prostate Cancer With Brachytherapy
| Brachytherapy seeds . Photo courtesy of Oak Ridge Associated Universities |
Prostate cancer is the most common type of cancer found in men in the U.S., second only to skin cancer. One man in six will get prostate cancer in his lifetime. The American Cancer Society estimates that in 2009, more than 192,000 men will be diagnosed with prostate cancer and more than 27,000 men will die from the disease.
Radiation therapy is one way to treat prostate cancer. This treatment uses high-energy rays to kill cancer cells and shrink tumors. Internal radiation, or brachytherapy, is a form of radiation therapy. In a brachytherapy procedure, small radioactive pellets are inserted into the prostate, delivering a concentrated radiation dose to the cancerous area.
To plan an implant, doctors analyze ultrasound images of the patient’s prostate and determine how many pellets will be needed and where each pellet should be placed. Anesthesia is typically used during the implant procedure. Hollow needles are inserted into the prostate through a needle template guide. The pellets are distributed throughout the entire prostate. Two types of radioactive seeds, iodine-125 and palladium-103, are commonly used. The 60-minute outpatient procedure allows most patients to return to work within a few days.
Va Benefits For Prostate Cancer
If you have been exposed to Agent Orange and developed prostate cancer, you may qualify for substantial compensation from the Department of Veterans Affairs . These contaminants may have lingered in your body for decades and your body is just now beginning to show symptoms of being exposed to these harmful chemicals. You deserve compensation from the VA for your diagnosis.
What Is Prostate Cancer
Prostate cancer is a type of cancer that affects the prostate gland, which is a small walnut-shaped organ that sits beneath the bladder and in front of the rectum. Prostate cancer usually grows slowly and is initially confined to the prostate gland, where it may not cause serious harm.
Veterans are more likely to be exposed to toxic chemicals throughout their service. Agent Orange exposure and burn pit exposure are two examples of toxic exposures linked to an increased risk of prostate cancer.
Symptoms of prostate cancer dont usually appear in the early stages of the disease. When they do, they may be similar to those caused by benign prostatic hyperplasia , a noncancerous prostate gland enlargement.
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Va Disability For Prostate Cancer
Prostate cancer is the 2nd most common type of cancer in men. The American Cancer Society estimates that about 1 in 8 men will be diagnosed with prostate cancer in their lifetimes.
As with other cancers, prostate cancer is caused by cells with abnormal DNA. Abnormal DNA can come from inflammation in the prostate, which can damage cell DNA, or exposure to cancer-causing material, which causes DNA mutations.
Presumptive Service Connection For Agent Orange Exposure
Due to the terrible exposure to Agent Orange during the Vietnam War, the VA has a presumptive service connection for prostate cancer. This means that if you served in Vietnam during the war and have been diagnosed with prostate cancer, the VA will automatically assume that your cancer was caused by your exposure to Agent Orange. This includes Blue Water Navy veterans who served in Vietnam but never went on land.
Read our article on Agent Orange presumptive service connection for more information on the dates of service and countries that make you eligible.
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Pact Act Gives Gulf War And Post 9/11 Veterans Presumptive Service Connection For Prostate Cancer
The PACT Act is a huge win for thousands of veterans. Now, veterans who served in the Gulf War and Post 9/11 are eligible for burn pit presumptive service connection for their prostate cancer.
Under the PACT Act of 2022, prostate cancer is considered presumptive under one of the 11 new categories of conditions added to the Airborne Hazards and Burn Pit Exposures.
Prostate Cancer As A Presumptive Condition
Veterans who meet specific service criteria may be approved for disability benefits as a presumptive condition. Prostate cancer is a presumptive condition for veterans exposed to Agent Orange or burn pits.
Agent Orange and prostate cancer
Veterans exposed to the tactical herbicide Agent Orange during their service may be eligible for disability benefits for prostate cancer as a presumptive condition. Agent Orange was primarily used during the Vietnam War to remove leaves, plants, and other vegetation that provided cover for the opposition. However, chemical compounds in the herbicide were toxic, and anyone exposed could have adverse health effects.
Veterans seeking disability benefits for prostate cancer as a presumptive condition to their Agent Orange exposure must submit a medical record showing their diagnosis and military records to prove they served in an area known for exposure to the herbicide.
Veterans with other prostate conditions or health conditions related to Agent Orange exposure that are not listed as one of the presumptive conditions may still be eligible for disability benefits. However, these veterans must provide a medical nexus connecting their service to their health condition.
Burn pits and prostate cancer
The VA estimates that over the last two decades, more than 3.5 million troops were exposed to burn pits. The toxic smoke from burn pits has been known to cause health issues for veterans living and working near them.
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The Link Between Agent Orange And Prostate Cancer
Agent Orange is one of many herbicides used during the Vietnam War. Its made of two toxic chemicals that give off a highly toxic and dangerous byproduct linked to multiple types of cancers and other diseases. Many Vietnam veterans were exposed to Agent Orange, as well as veterans who served in Korea and nearby areas during these wars.
Service Connection For Cancer
In order to receive VA disability benefits for cancer, you must establish service connection. For direct service connection, you must prove to VA that you are currently diagnosed with cancer and that it is at least as likely as not the result of your military service.
In general, VA requires evidence of these three elements of service connection:
- An in-service event, injury, or illness
- A current diagnosis by a medical professional
- A medical nexus, or link, between the in-service event and current diagnosis.
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Individual Unemployability & Special Monthly Compensationfor Prostate Cancer
For Blue Water Navy veterans who are finally able to take advantage of the presumption of service connection for prostate cancer based on Agent Orange exposure, it is important to make sure that the VA has rated your condition correctly and has not reduced your benefits if you are still entitled to them. It is also important to submit VA claims for a secondary service connection for any conditions that are caused by your prostate cancer. You should also apply for a Total Disability Rating based on Individual Unemployability if your prostate cancer prevents you from obtaining and maintaining a gainful occupation. If you are experiencing unemployment as a residual of prostate cancer, it is important to file a claim for individual unemployability with the VA, not only so you receive benefits at the 100 percent rate, but so you can receive Special Monthly Compensation as well.
Dic Benefits For Surviving Spouses
If you had boots on the ground in a place with Agent Orange, your prostate cancer is presumed to have come from your Agent Orange exposure. Since those veterans are eligible for benefits, their surviving spoused may be eligible when they pass.
If you are the surviving spouse of a veteran that died from prostate cancer, you may be eligible for DIC benefits for widows. According to a VA study, veterans exposed to Agent Orange are not only at a higher risk for prostate cancer, but are also more likely to develop aggressive forms of the disease. Woods & Woods DIC veteran widow benefits lawyers have fought the VA in many DIC claims for Agent Orange related illnesses.
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Denied Va Disability Benefits For Prostate Cancer
VA disability claims for prostate cancer, specifically stemming from exposure to military burn pits, may be denied by VA because there is no presumption of exposure. However, if your claim for prostate cancer was denied, you still have options for appealing the decision.
The accredited VA disability attorneys at CCK may be able to help you secure VA disability benefits for your prostate cancer. Contact our office today for a free consultation.
Va Rating For Prostate Cancer Residuals
Once youve been off treatment for six months and your prostate cancer is in remission , the VA will assign a residual rating. A residual rating is given to any condition that persists after treatment has ended.
Several common residual conditions occur after veterans have recovered from prostate cancer. For example, suppose you had surgery to remove your prostate gland and are now incontinent. In that case, youll receive up to a 60 percent VA rating for prostate cancer. This is the highest residual rating for incontinence.
Urinary incontinence is also called voiding dysfunction by the VA and is rated from 20% to 60% based on these criteria:
- 20% You wear absorbent materials and only change them once daily.
- 40% You change absorbent materials two to four times daily.
- 60% You wear an appliance or change absorbent materials more than four times daily.
Incontinence is one of the highest permanent ratings you can receive after your cancer is no longer active, at a 60 percent VA rating for prostate cancer.
Urinary frequency is rated from 10% to 40% based on these criteria:
- 10% You go every two to three hours or wake up twice each night to urinate
- 20% You go every one to two hours or wake up three to four times each night to urinate
- 40% You go less than every hour or wake up five or more times each night to urinate
Atrophied testes are another possibility, depending on the treatment, rated from 0% to 20%. To be rated at 20%, both testes must be impacted.
Watchful Waiting
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Vietnam Veterans Need To Know About Va Benefits
When I got sick and could no longer work, my wife and I were really getting nervous. Bills were piling up and, though we have health insurance from her job, it didnt cover everything. It really was by chance that I found out I could get help from the VA because Im a Vietnam veteran. I dont know why I didnt think of it. I suspect that there are many Vietnam veterans who are seriously sick and dont know that their conditions could have been caused because they were in Vietnam. They need to know that they can apply for financial help, and get it, like I did.
Va Rating For Prostate Cancer
Prostate cancer is listed under diagnostic code 7528 malignant neoplasms of the genitourinary system. The VA rates prostate cancer at 100% during cancer treatment and six months afterward. At the end of six months, a re-examination is required to determine a new rating. In addition, any ongoing disabilities related to cancer contribute to the VA disability rating for cancer in remission.
They brought me from being stuck at 30%. Denial after denial. Finally rated at 70%. Appealed for total and unable to work disability since 2014. Without Woods and Woods I would still be stuck at 30%.
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What Does A Va C& P Exam Consist Of
The purpose of the C& P exam is to determine whether your condition is related to service and/or the extent of your service-connected disability. It is not much different than a doctors appointment you will answer questions about your condition and the examiner will evaluate your condition with a series of tests that will vary depending on your condition.
What You Need To Know About The Prostate Does Va Reduce Compensation Rating For Prostate Cancer After Treatment
A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.
While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.
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What Does All This Mean For Veterans With Prostate Cancer Claims
This case was a little complicated because of all the side issues of protecting effective dates, using VA forms, etc. So lets boil out the important facts for veterans trying to maximize their VA prostate cancer rating.
#1: Tell the VA every complication of your prostate cancer.
In your original claim for prostate cancer, tell the VA all of the complications of your prostate cancer even before it goes into remission.
You can tell the VA this in three ways: lay evidence, medical evidence, and expert opinions. The best course of action is to use all three tools.
If you use lay evidence, be sure to focus on the frequency, chronicity and severity of your prostate cancer complications and residuals and their impact on your earning capacity. It has been my experience over the last 13 years that lay evidence when done right is the silver bullet in your VA claim or appeal.
You can bolster your lay evidence with medical evidence showing the complications and residuals of your prostate cancer. This isnt technically necessary, but it is incredibly helpful if you can back up what you tell the VA with evidence in your medical records.
And, if you decide to use an expert opinion, present your lay evidence, medical evidence and a copy of your VA claims file being especially sure to include adverse medical opinions to the expert to ensure that his or her opinion is thorough.
#2: Dont let the VA cut you out of an earlier effective date for your prostate cancer ratings.
Treatment Options Under Clinical Evaluation
Treatment options under clinical evaluation for patients with prostate cancer include the following:
Cryosurgery
Cryosurgery, or cryotherapy, is under evaluation for the treatment of localized prostate cancer. It is a surgical technique that involves destruction of prostate cancer cells by intermittent freezing of the prostate with cryoprobes, followed by thawing. There is limited evidence regarding its efficacy and safety compared with standard prostatectomy and radiation therapy, and the technique is evolving in an attempt to reduce local toxicity and normal tissue damage. The quality of evidence on efficacy is low, currently limited to case series of relatively small size, short follow-up, and surrogate outcomes of efficacy.
Serious toxic effects associated with cryosurgery include bladder outlet injury, urinary incontinence, sexual impotence, and rectal injury. Impotence is common, ranging from about 47% to 100%.
The frequency of other side effects and the probability of cancer control at 5 years’ follow-up have varied among reporting centers, and series are small compared with surgery and radiation therapy. Other major complications include urethral sloughing, urinary fistula or stricture, and bladder neck obstruction.
Proton-beam therapy
Vascular-targeted photodynamic therapy using a photosensitizing agent has been tested in men with low-risk prostate cancer.
Neoadjuvant hormonal therapy
The role of neoadjuvant hormonal therapy is not established.
Bicalutamide
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Conservative Management Increasing In All Age Groups
Researchers noted a substantial rise in the use of active surveillance during the study period across all age groups. During the study period, the percentage of men younger than age 65 who opted for watchful waiting or active surveillance over surgery jumped from 27 percent to 72 percent, with a similar increase seen among older patients.
During the study period, the percentage of men younger than age 65 who opted for watchful waiting or active surveillance over surgery jumped from 27 percent to 72 percent, with a similar increase seen among older patients.
Conservative management overall was more likely for men who were black, older age, unmarried, higher PSA, increasing comorbidity, and living in certain geographic regions. Among men choosing conservative management, those older than 75 years, with higher PSA scores, and with greater comorbidity were more likely to receive watchful waiting as opposed to active surveillance.
Genetic Testingthe New Standard In Treatment For Advanced Prostate Cancer
“The first step is a conversation with your cancer doctor about the purpose of the testing and its possible benefits in selecting your cancer treatment, as well as possible harms and limitations.”
Prostate cancer is one of the most common cancers in VA patients. The disease most often affects older men, age 65 and above.
VA has been partnering with the Prostate Cancer Foundation to ramp up the use of precision oncology to treat Veterans with metastatic prostate cancerdisease that has spread from the prostate gland to other areas of the body. Precision oncology involves giving genetic tests to patients and using the results to help guide treatment.
VA Research Currents spoke with two experts to learn more about how Veterans with advanced, or metastatic, prostate cancer can be helped through genetic testing and precision oncology. The answers below were provided by Dr. Julie Graff, an oncologist with the Portland VA Health Care System and Oregon Health and Science University and Dr. Maren Scheuner, a physician and geneticist at the San Francisco VA Health Care System and the University of California, San Francisco.
Related Articles
VA Research Currents:What is the purpose of genetic testing for men with metastatic prostate cancer?
What are genes and how do they contribute to cancer?
How do gene mutations happen?
How does your healthcare provider get a sample of your DNA for genetic testing?
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