What is unique about the human race is our need for knowledge—especially when it suits us or we simply have to know. For instance, unless you are a man with prostate problems or the loved one of a man suffering the treatments for prostate cancer, it is unlikely you realize that one of the nation’s leading authorities on prostate cancer and health practices daily at Wheeling Hospital in Wheeling, W.Va.  It is surely no secret---with patients from 31 states and 11 foreign countries ranging from high-ranking foreign diplomats to members of the U.S. Congress, all seeking Dr. Gregory S. Merrick’s expertise to solve their prostate cancer-related issues and treatment every day---that something big is happening at Wheeling Hospital.  A leader in the fight against prostate cancer, Merrick established himself as a national authority in the mid-1990s when he and his team enhanced the brachytherapy treatment technique to improve the success rate of treatment for the early stages of localized prostate cancer.

It is important to note that prostate cancer is the second leading cause of cancer-related deaths for men in this country, and it is the most common form of cancer, excluding skin cancer, in the U.S. In fact, it is expected that one in six men will develop prostate cancer and more than 30,000 men will lose their lives to the cancer this year alone, thus making advances in treatment for the cancer so vital.  Enter Wheeling Hospital with Dr. Merrick and brachytherapy.  Brachytherapy, or radioactive seeding, is a cutting edge form of radiation therapy for prostate cancer. According to a leading manufacturer of the radioactive seeds, Theragenics Corporation, brachytherapy is defined as the precise placement of radioactive seeds that will target the cancer of the prostate while minimizing the radioactive exposure and damage to nearby tissues and organs.   “We know brachytherapy is less invasive and offers the highest cure rates with the lowest complications,” Merrick says citing his research.  A documented professional in his field, Merrick sits on the editorial board of the journal Brachytherapy and serves as a manuscript reviewer for numerous other peer-reviewed scientific oncologic and urologic journals.  He has published more than 250 manuscripts, abstracts and other scientific publications on urologic cancers, with an emphasis on prostate cancer.  Merrick was the senior editor of the only comprehensive brachytherapy textbook ever published; another textbook will be published this year. In an educational video, Dr. Merrick notes that all cancer treatments now have a less invasive focus, not only for cure, but for the quality of life outcome as well. 

Common Complications

Radical prostatectomy surgery often causes complications and side effects of incontinence and impotence. The direct cause of these issues would be the location of the prostate.  The urinary canal, or urethra, penetrates the center of the prostrate before connecting to the bladder. In a radical prostatectomy, the urinary canal must be completely severed in order to remove the prostate. The canal is then sutured which often causes loss of bladder control post-surgery. The removal of the prostate also affects nerve endings that control erections and, therefore, cause post-surgery issues of impotence.  “Even the use of nerve sparing techniques employed during surgery show that patients still experience sexual performance problems” Merrick says. “With brachytherapy, we are killing the cancer, leaving the prostate intact and instead of using a knife, we do it with a seed causing fewer complications and less long term quality of life impact.”  

Other Options

Merrick is not alone in the advancements of radical prostatectomy alternatives. Recently, physicians and researchers have been working on Laparscopy and Robotic Radical Prostatectomy surgeries.  Another non-invasive option is cryotherapy, which attempts to kill the cancer by freezing the prostate. The issues of cryotherapy treatment include the necessity to maintain urethra warmth so as to prevent severe urinary complications. “These treatments lack long term data, so true efficacy is unknown,” Merrick says. “The exposure of healthy tissues and organs also increases the likelihood of additional side effects.” This begs the question: if brachytherapy is such an unproblematic alternative to surgery, why then are so many men unaware of the option? Quite simply, Merrick notes, surgery is often the first and only option many patients are offered by doctors, and many men are reluctant to get a second opinion or do the research.  Many times, research works for the patient and the alternatives are the best option.  In 1999, the issue of prostate cancer and men’s health was propelled into the national spotlight when New York City Mayor Rudolph Giuliani discussed his cancer diagnosis and the treatment option he chose. Giuliani chose TheraSeed ® brachytherapy with Paladium-103(Pd-103).  In an interview on Larry King Live on CNN, Mayor Giuliani said, “I thought this worked better…and I thought I could just handle it better. It was just a better chance of killing the cancer.” 

Why It Works

The treatment Mayor Giuliani selected included the radioactive isotope Palladium-103. There are two radioactive isotopes to treat cancer: Palladdium-103 (Pd-103) and Iodine-125.  Merrick’s research demonstrates Pd-103 is a better alternative because it offers three times the initial dose of radioactive treatment, works two to three times faster and has a has a shorter life span and shorter duration of potency, which significantly lowers complications. On the other hand, Iodine-125 delivers a less powerful dose but remains active far longer in the patient’s system.  “Palladium-103 offers faster recovery to normal urinary function,” Merrick says. “Patients also suffer less erectile dysfunction than with surgery and tend to respond better to erectile stimulating drugs.”  Research and progress are continual processes, Merrick says, and his commitment is ongoing and never-ending.  “When I first began my specialization in this field, the medical community had just started to readily accept the Prostate Specific Antigen or PSA test analysis to diagnose prostate issues for men and more than half were incurable,” Merrick says. “Today, it is like night and day to when we first started, but there is still work to do.”  Merrick has recently participated as co-principle investigator in the only three large prospective randomized prostate brachytherapy trials ever completed, and another four are currently being initiated.   He continues to define the standard of care by aggressively researching and striving for the best possible treatment options and outcomes for prostate cancer patients. While his continued research is his priority, Merrick also subscribes to the truism that “an ounce of prevention is worth a pound of cure.” 

In 2005, Dr. Merrick implemented a transperineal saturation biopsy program to diagnose prostate cancer, especially in men who were not diagnosable via standard biopsies.  The Schiffler Cancer Center of Wheeling Hospital is one of less than 10 hospital specialization oncology centers using this procedure. Last March, the Urological Research Institute at Wheeling Hospital was established under Dr. Merrick’s guidance. Serving as the executive director, Merrick guides the institute to focus on prevention, diagnosis and treatment of prostate cancer and other urological disorders.  “Women are well versed about their bodies and their health and they understand the importance of screening,” Merrick says. “Men most often are directed to the doctor by the urging of their wives.”  Merrick notes that the average man will suffer or deal with an issue for four or six months, greatly increasing the risk of issues because of a fear of surgery and concerns about the side effects of impotence and incontinence with traditional treatments. In July, under Merrick’s guidance, the Urological Research Institute at Wheeling Hospital teamed with Wheeling Jesuit University to provide an educational program for high school aged boys on the dangers of testicular cancer and how to detect it.  The program employs an overview video presentation for health education teachers to utilize in their classrooms and will have a web-based learning system. Health teachers will be required to pass an online exam prior to teaching the program in the classroom.  

The program will further gauge retention in schools and retention between male and female students.   Clearly one of the world’s leading physicians in his field, it is no secret Merrick could practice this advanced medicine anywhere; he chooses Wheeling Hospital.  “I have always subscribed to the school of thought that who you are is defined by who you are surrounded by,” Merrick, the Wheeling native says. “In all my years of practice and experiences, this is the most talented and skilled staff I have ever worked with–from nursing, to physics to pathology.” Dr. Gregory Merrick might be described as a teacher, leader, researcher or a pioneer.  Whichever you choose to describe Dr. Gregory Merrick, his passion and commitment to men’s health throughout West Virginia and around the world is nothing short of remarkable.    Pull Quotes:It is surely no secret---with patients from 31 states and 11 foreign countries ranging from high-ranking foreign diplomats to members of the U.S. Congress, all seeking Dr. Gregory S. Merrick’s expertise to solve their prostate cancer-related issues and treatment every day---that something big is happening at Wheeling Hospital.  While his continued research is his priority, Merrick also subscribes to the truism that “an ounce of prevention is worth a pound of cure.”