brachytherapy (seeds) success rate

Replicant · Moderator Joined: 01 Nov 2006 Posts: 849

"Brachytherapy regarded as superior treatment for prostate cancer
<excerpt>
September 2, 2009
In an 11-year study, the Prostate Cancer Foundation of Chicago, a non-profit organization that funds patient support programs, clinical research and public education, analyzed 9,137 patients between 1997 and 2008 who were treated for prostate cancer with brachytherapy at Chicago Prostate Center. 67.5% of the patients were regarded as low risk, 29.36% as intermediate, and 1.01% as high.

Of those patients, overall cure rates were 96%, 84%, and 75% for low, intermediate, and high risk patients, respectively. When combined with external beam radiation therapy in intermediate and high risk patients, the brachytherapy results far exceed those of surgery..."
http://www.news-medical.net/news/20090902/Brachytherapy-regarded-as-superior-treatment-for-prostate-cancer.aspx

"Recurrence Rate Similar Between Common Treatments for Early Prostate Cancer
According to a recent article published in Radiotherapy and Oncology, cancer recurrence rates, as determined by prostate specific antigen (PSA) levels, are nearly equivalent between patients treated with a radical prostatectomy, external beam radiation and interstitial radiation therapy for localized prostate cancer." Note from Rep: "interstitial" refers to seeds.
Us TOO International http://www.ustoo.org/Article_1.asp?display=article&id=23576

"After 12 years the American Society for Therapeutic Radiology and Oncology (ASTRO) defined the biochemical-free recurrence at 81%, ASTRO-Kattan at 78%, ASTRO-Last Call at 74%, and Houston at 77%. Using the ASTRO-Kattan definition, patients at low risk could achieve 89% biochemical-free recurrence, those at intermediate risk 78%, and those at high risk 63%."
http://www.prostate-cancer.com/brachytherapy/survival-rates/brachytherapy-survival-rates.html
“12-Year Outcomes Following Permanent Prostate Brachytherapy in Patients with Clinically Localized Prostate Cancer”
Louis Potters, Carol Morgenstern, Emil Calugaru, Paul Fearn, Anup Jassal, Joseph Presser and Edward Mullen The Journal of Urology 173 (2005) 1562-1566
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

johnT · Senior User Joined: 27 Apr 2009 Posts: 233

Seattle Prostate Institute results:
10 year followup: Procedures in 1987-1993
83% progression free with Paladium 105
87% progression free with I 125
Local control 97%
Metastic free survival 97%
http://www.prostate-cancer.org/education/localdis/grimm_seed_implantation.html
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

JustJB · Posted: Sun Sep 13, 2009 2:15 am Post subject: Verrry interesting

Thanks for these links, guys. Very interesting. Overall now, I am more undecided after reading these studies.
_________________
Age 52
RRP 11-5-09
Post Surgical Gleason 3+4 = 7
Stage T1C
Pre-surgical PSA: 5.3
Post-surgical PSA: Undetectable at 13 weeks

johnT · Senior User Joined: 27 Apr 2009 Posts: 233

JB,
Brachytherapy is worth another look. It is the most cost effective, convenient and has the least side affects of all the local treatments.
I had seed implants in May, a 45 min procedure that was painless. I was home an hour later and played golf the next day. I had frequent urination and urgency for about 4 weeks that was very tolorable and didn't interfere with my daily life. No other side affects. I may get ED in about 3 years, but should be OK with meds like Viagra. ED rate is about the same as nerve sparing surgery.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

holler1 · New User Joined: 07 Aug 2009 Posts: 7

Because of my location and possible diagnosis (2nd biopsy a few days ago), I've been following news on Cleveland Clinic. The CC Taussig Center recently posted outcomes from brachytherapy compared with surgery and external beam therapy. There was also a news story on that along with the Chicago results posted above. I suppose I can't post the websites due to forum policies, so I won't attempt it.

Here is a quote from the news story regarding the CC outcomes.
"The Taussig Cancer Center at Cleveland Clinic has released their similar 2008 outcomes, demonstrating brachytherapy to be superior to surgery in all cases. For low risk patients, the study found a 95% survival rate after five years, 89% for intermediate risk, and 71% for high risk patients. This research concluded that, for low risk patients, brachytherapy was equally successful as external beam radiation, but more successful than a radical prostatectomy."

The posted results cover years from 1996 to 2008 for ~8000 total patients. They report 12 years of outcomes (biochemical relapse-free survival rates) for surgery and EB and 11 years for brachytherapy. I thought it was interesting that for low risk patients the EB survival rates for 12 years are slightly better than for surgery, while the brachytherapy results for 11 years are also better than surgery. However, the differences are not very large and perhaps not statistically significant. The differences for intermediate and high risk are larger. For high risk, both radiation schemes are better at all years, while for intermediate risk, radiation is better at 5 years but tends to converge with surgery at 7-10 years out.

JustJB · Posted: Fri Sep 18, 2009 12:34 am Post subject: Cleveland

Holler, thanks for that info. I just read the release. Very interesting reading. Definitely will have an effect on my choice!
_________________
Age 52
RRP 11-5-09
Post Surgical Gleason 3+4 = 7
Stage T1C
Pre-surgical PSA: 5.3
Post-surgical PSA: Undetectable at 13 weeks

problem · Regular Joined: 12 Sep 2009 Posts: 42

Does everyone have to get hormone shots before all types of radiation? even proton beam at Loma Linda? and seeds?

doesn't that give you ED for sure?

Replicant · Moderator Joined: 01 Nov 2006 Posts: 849

No, not everyone gets hormone therapy before radiation, but some do, especially those at high risk (high Gleason, positive seminal vesicles, etc). In addition, some forms of therapy are not effective on large prostates, so sometimes men go on hormone therapy to reduce the prostate volume before treatment.

Since it blocks testosterone, hormone therapy pretty much kills your sex drive (libido) but that recovers once you're done, or when you take an extended break. So it's not like it causes some kind of permanent or persistent ED.

A friend who has been on hormone therapy says that it makes every woman seem like a close relative--there's just no sexual interest there. It can (I think) be more disturbing for one's sexual partner than oneself, since the patient simply isn't interested in sex while on the therapy.

Those of you who are on or who have been on ADT can correct me if I got any of this wrong. Please do.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

problem · Regular Joined: 12 Sep 2009 Posts: 42

Thanks for your reply!

My doc just suggested surgery, so I don't have any info on radiation.

I've been reading thread after thread and running searches here, seems like most of the men who have surgery end up doing radiation after the fact, as it seems the surgery may make the cancer spread if it's already in the nerves, or outside the gland. and I guess, if it's outside then radiation is the choice, but they don't really know this until they open you up?

Is your crystal ball handy?

johnT · Senior User Joined: 27 Apr 2009 Posts: 233

Replicant,
You are correct. On HT you can still get an errection, you just don't want to. You can take Casodex alone to reduce prostate size prior to seeds or radiation and it has about 20% of the side affects of Lupron with just as good results.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

cantexplain

With external radiation, one of the caveats is, if it doesn't work surgery is not a reasonable option to follow. What of Brachytherapy? Any information regarding surgery following brachytherapy?

Cantexplain
------------------

Age; 56
PSA: 4.9
Gleason: 3+3 =6
Stage: T2a
1 core in 10

BobH · New User Joined: 22 Oct 2009 Posts: 1

I had seed implants in 2006 at age 56. Now 59 and have serious ED and frequent urnination and a rising PSA from 0.1 to 0.3 in one year. unemployed and pay COBRA but cannot affored ED drugs and just scared about what to do. Have upcoming appt with urologist.

What can anyone suggest. I am a vet. but never checked into it untill someone suggested a Urologist there.
_________________
Seed Implant 2006
PSA after 6 months 0.1
PSA after 2 yers 0.3

johnT · Senior User Joined: 27 Apr 2009 Posts: 233

Bob,
Small rises in PSA are common after any radiation. biochemical relapse is defined as 3 consecutive rises in PSA.
Are you taking Flowmax for your frequency?
Can't help you on the ED part; but most seed patients have a positive result with most of the common ED meds.
I would stay away from the VA if at all possible, might be good for a 2nd opinion from a prostate specialist if they have one, but getting treatment from them would be a last resort for me.
If you have Cobra get an opinion from a prostate oncologist, but I think with your slow rise you may not have a problem.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

johnT · Senior User Joined: 27 Apr 2009 Posts: 233

Can't Explain,
Surgery is not a good option after Brachytherapy, but there are other salvage therapies available; Additonal brachytherapy with a different type if radioactive seeds, ie Idodine 125 or Pladium 105 depending of what you had first; High dose temporary Brachytherapy, Cryosurgery and HIFU are also available as salvage therapies.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

G2e4n3e4 · Regular Joined: 13 Apr 2009 Posts: 25

Hi BobH,

I had seeds in Jan 08, which failed as confirmed by 3 rising PSA's as of April 09. Began Lupron hormone therapy (expensive, but may be covered under COBRA, about which I know very little). My PSA went from 3.9 down to 0.5 in 4 mos after first shot (in hip). Second shot on Aug. 21. Will get next PSA test about mid Dec. Next shot due Dec. 21, a welcome Christmas present Smile

I also suggest Flomax if you are not now on it. A urologist who chairs our local support group recommended 2 Flomax to help me with emptying bladder - not a serious problem, just a minor nuisance. I took 2 for a few days - they helped.

Bottom line. I agree with John that a review of your case by a medical oncologist might help. Ask about hormone therapy. Quite a few on this forum or on the HealingWell Forum have had great success with that treatment.

Wishing you all the best in your confrontation with PCa.

Gene in Md
_________________
Age 70 Dx Dec 07 PSA 8.4 DRE positive. Gleason 6 (3+3), T2 PC confined to prostate. Brachytherapy Jan 2008 failed rising PSA's. Began Lupron 30 MG ea 4 mos. hot flashes, fatigue. Occasional urinary and rectal bleeding. Aug 09 - PSA 0.5. Lupron is working!!! Aug 21, 09 - 2nd Lupron shot. Continuing hot flashes. Doc recommends weight lifting - 20 to 30 lbs. July, Aug, Sep. rectal bleeding - hyperbaric chamber treatments.

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