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Thread: What I Need to Know About TWO TYPES of Brachytherapy

  1. #11
    Moderator Top User HighlanderCFH's Avatar
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    Good luck, Geez!!
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Seven annual post-op exams 2012 through 2018: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  2. #12
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    HI Geez:

    It is my understanding that the HD Brachy monotherapy is not indicated for "high risk", thus I assume this is why your HCP's are going for a multi-pronged approach.

    I am curious as to whether or not you considered surgery, and if so, why you chose the alternate path of radiation?

    Best of luck in your treatment!
    Enlarged prostate & protastitis since my 30's
    Completely asymptomatic in terms of sexual/urinary function
    PSA 2008 2.4
    PSA 2011 4.06
    PSA 2105 7.0 (free PSA 0.72)
    PCa Dx May 2015 from biopsy age of 64 (2/12 cores 10% involvement)
    Follow-up MRI guided biopsy in February 2016 DXd adenocarcinoma in
    9/20 cores ranging from 5%-70% involvement
    Gleason scores mixed 3+3=6. And 3+4=7
    2 rounds of High Dose Brachytherapy as Monotherapy at Stanford 4/20/16 & 5/5/16
    PSA August 2016: 2.45 (over 50% drop!)
    PSA November 2016: 1.54
    PSA March 2017: 1.46
    PSA June 2017: 1.45
    PSA November 2017: 1.24
    Told to expect PSA "bounces" typical of this therapy and not to worry unless they go up 3X in a row.
    No urinary, bowel or ED side effects noted. Take an occasional 1/2 Viagra or Cialis if I feel I might need it.

  3. #13
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    Quote Originally Posted by Lumore51 View Post
    HI Geez:

    It is my understanding that the HD Brachy monotherapy is not indicated for "high risk", thus I assume this is why your HCP's are going for a multi-pronged approach.

    I am curious as to whether or not you considered surgery, and if so, why you chose the alternate path of radiation?

    Best of luck in your treatment!

    Good question. Until a couple weeks ago we were determined surgery was our option. I am 71, but active. Easy for me to get up and walk two miles briskly, cut and haul firewood and work around the house. However, I have a couple other issues so after consult with three doctors we decided to opt for radiation. I do know two individuals that had surgery at my age, but I was advised the probably of radiation due to extraprostatic extension even after surgery would be great. The surgeon said he would expect positive margins after surgery and that meant radiation. They felt side effects to the urinary track and other organs from both procedures would be a chore to overcome if at all. I checked with Northwestern University URO's and one of the Docs there pioneered PSA tests and have accomplished thousands of surgeries. He felt 71 was a break point for surgery and I could be prone to complications.

    Radiation from I have read and briefed has come a long way and if they can give me 10 years that puts me well beyond expected life span. Not trying to rush God's order, just make a common sense decision. My brother-in-law at age 70 had surgery and he experienced a long ordeal with urinary issues and still ED, but he did not have have supplemental radiation, so I am guessing his PC was way early and may not even have needed treatment.....just a guess.

    So thats it, hopefully the side affects from radiation wont be quite as severe, tolerable and a quicker recovery. The Docs are optimistic. Dunno if that makes sense or helped but that is the history to our decision. Butch

  4. #14
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    That sounds like very sound reasoning to me, Butch. I am "only" 64 and also very active on all fronts and really not liking the potential side effects that the surgical option can result in-and there will be at least some, with no real way to determine the severity in advance..

    At this point unless I can be convinced that surgery really does offer me the least chance of recurrence and fewer side effects-and based on the statistics I've seen that doesn't seem to be the case-I am leaning towards radiation. Seems like radiation can kill a lot of "errant" cells that surgery might miss, and with the more targeted techniques, less damage to surrounding tissues than previously. Until I met with the radiologist and he advises that I am a better surgical candidate, I too am leaning towards Brachy.

    Wishing you all the best! Keep us posted.
    Gio
    Enlarged prostate & protastitis since my 30's
    Completely asymptomatic in terms of sexual/urinary function
    PSA 2008 2.4
    PSA 2011 4.06
    PSA 2105 7.0 (free PSA 0.72)
    PCa Dx May 2015 from biopsy age of 64 (2/12 cores 10% involvement)
    Follow-up MRI guided biopsy in February 2016 DXd adenocarcinoma in
    9/20 cores ranging from 5%-70% involvement
    Gleason scores mixed 3+3=6. And 3+4=7
    2 rounds of High Dose Brachytherapy as Monotherapy at Stanford 4/20/16 & 5/5/16
    PSA August 2016: 2.45 (over 50% drop!)
    PSA November 2016: 1.54
    PSA March 2017: 1.46
    PSA June 2017: 1.45
    PSA November 2017: 1.24
    Told to expect PSA "bounces" typical of this therapy and not to worry unless they go up 3X in a row.
    No urinary, bowel or ED side effects noted. Take an occasional 1/2 Viagra or Cialis if I feel I might need it.

  5. #15
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    Quote Originally Posted by Lumore51 View Post
    That sounds like very sound reasoning to me, Butch. I am "only" 64 and also very active on all fronts and really not liking the potential side effects that the surgical option can result in-and there will be at least some, with no real way to determine the severity in advance..

    At this point unless I can be convinced that surgery really does offer me the least chance of recurrence and fewer side effects-and based on the statistics I've seen that doesn't seem to be the case-I am leaning towards radiation. Seems like radiation can kill a lot of "errant" cells that surgery might miss, and with the more targeted techniques, less damage to surrounding tissues than previously. Until I met with the radiologist and he advises that I am a better surgical candidate, I too am leaning towards Brachy.

    Wishing you all the best! Keep us posted.
    Gio
    Well, I can only tell ya in my case if I had NOT had a colon resection due to diverticulosis (severe continual infections) and if I was a few years younger, unless there was a clinical reason or PC was so confined they were certain RT was the ticket, I probably would have opted for surgery. PLEASE UNDERSTAND, I am not trying to sway your decision. What I have learned in the last few months is that each case is different and there is safety in a multitude of counselors....hence the lessons learned from places like this forum and second opinions are very valuable.

    Your gleason report is similar to mine. My PSA was 3.2 so that did not add up, actually it dropped .7 from last year. Figure that one out.

    I have learned prostate size can influence type of brachy options and last week Drs accomplished a prostrate ultrasound to determine its size. Evidently it was within guidelines because no markers were installed; hence, the three fold option that was put forth to me, ofcourse I knew that going in was just waiting for the test results.

    I do wish you the very best. Many folks on here recommend second opinions and that is sound wisdom....so do the books. The RT Docs told me URO's predominantly opt for surgery, so they were surprised my URO recommended I seek a reputable RT Dr for a consult.....RT Doc agreed with his assessment. These guys are salaried not based on patient volume. My URO gave me a list of reasons he felt radiation was his recommended option, I believe he was completely unbiased. That coupled with a Dr I have been with for 30 years and other inputs via telephone outlining my condition and research led to our conclusion.

    Like the old timers said to me, your first shot is your best. I trust you will make the best decision for your situation and I will post here how my brachy goes, but that is a few months down the road. Have not even had my first hormone shot albeit it is scheduled for Wednesday pending some little insurance snafoo bout who will give the shot, how cares?????

    all the best, Butch.
    Last edited by Geezer; 02-29-2016 at 05:41 PM. Reason: correct content

  6. #16
    I had previously replied concerning prostate cancer treatment involving a combination of High Dose Radiation (HDR) brachytherapy and external beam radiation (IMRT) that I received in early 2015. After treatment ended, I had a couple of PSA increases. My reading at 4 months after treatment was 0.67 ng/mL (my low point), after 8 months it was 0.72 ng/mL, and after 11 months it was 1.03 ng/mL. There are several definitions of treatment failure but the one I was operating under was more than 2.0 ng/mL over nadir (low point which at the time for me, was 0.67). I had my PSA taken yesterday and it was 0.58 ng/mL, a marked decrease from three months ago and lower than it has been since treatment was initiated. This is known as "PSA bounce" where PSA after treatment can increase and then drop back down. Reasons for this phenomenon are given in the literature but nobody really knows for sure. I think it's more likely with brachytherapy but also occurs with external beam radiation. In my case, I was told it occurs in 30% of men receiving the kind of treatment I had. I can't possibly express the kind of anxiety the PSA increase causes regardless of what I might have known about PSA bounce. Frankly, I thought I was the exception and was likely a treatment failure and was therefore preparing for next steps. Things turned out well although they did tell me that the PSA bounce can occur again. Anyway, I write this for anyone else out there who starts to see a PSA increase after radiation treatment and gets concerned about it. It might very well be PSA bounce and not a treatment failure.
    June 2014 PSA 4.1
    December 2014 PSA 4.4; January 2015 PSA 7.52
    Prostate 48 g
    Gleason 3 +4 in 3 posterior cores
    1 core 4 + 3 with tertiary pattern 5
    PC in 9 of 12 cores
    2 cores 50 - 60%
    No evidence of metastatic disease
    T2aN0M0 Stage II A
    HDR Brachytherapy (23Gy) + IMRT (45Gy) in February 2015
    PSA 1.64 (5/6/15); 0.67 (7/30/15); 0.72 (11/5/15); 1.03 (2/9/16); 0.58 (5/17/16); 0.56 (8/18/16); 0.55 (10/6/16); 0.36 (1/23/2017); 0.33 (6/12/2017); 0.17 (12/20/2017); 0.10 (12/20/201

  7. #17
    Experienced User
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    Posts
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    Hi Mark:

    I can imagine that the bounces are unnerving! I have only had my fist PSA test and it went down significantly.

    An interesting things that my doctor told me, that there is literature stating that PSA bounces after HD Brachy actually point to better long term outcomes! That sounds a bit crazy and counter-intuitive, but I will take it! I did not ask him for a copy of or a link to that particular literature, but I think I will and will post here if I can. That said, "literature" might mean some papers have been written on it, but that it is not an actual prospective study ( may be a retrospective study, which would still have validity).

    Gio
    Enlarged prostate & protastitis since my 30's
    Completely asymptomatic in terms of sexual/urinary function
    PSA 2008 2.4
    PSA 2011 4.06
    PSA 2105 7.0 (free PSA 0.72)
    PCa Dx May 2015 from biopsy age of 64 (2/12 cores 10% involvement)
    Follow-up MRI guided biopsy in February 2016 DXd adenocarcinoma in
    9/20 cores ranging from 5%-70% involvement
    Gleason scores mixed 3+3=6. And 3+4=7
    2 rounds of High Dose Brachytherapy as Monotherapy at Stanford 4/20/16 & 5/5/16
    PSA August 2016: 2.45 (over 50% drop!)
    PSA November 2016: 1.54
    PSA March 2017: 1.46
    PSA June 2017: 1.45
    PSA November 2017: 1.24
    Told to expect PSA "bounces" typical of this therapy and not to worry unless they go up 3X in a row.
    No urinary, bowel or ED side effects noted. Take an occasional 1/2 Viagra or Cialis if I feel I might need it.

  8. #18
    I am going to give you what I was told on the 2 types. Hey Doc, what type is better? He said, High dose is as placement is better as they focus on it. With low dose, the seeds stay in and they migrate a bit so the surgeon is not as concerned about placing them in the exact place. I DO NOT KNOW IF HE WAS JUST SAYING STUFF OR BASING IT ON FACTS. I think that HDR therapy coupled with a fusion for placement would be awesome. I am unaware if the can do it. They use the fusion technigue to target the biopsies to get the best results of hitting the tumor, why not target the HDR in the hot spots of your prostate (where the tumor is likely to be). Would not hurt to ask your radioligist/uroligist if they can use the fusion to target, I do not know if it is not possible, they have not thought of it, or they already do it.
    PSA 5/12 14.1 10/12 19.66 11/12 20.23 12/12 1.93 1/13 0.17 2/13 0.09 3/13 0.02 6/13 0.35 9/13 0.49 10/13 0.40 1/14 0.40
    DRE Normal. CAT, MRI, and bone scan all normal.
    Biopsy 10/12. 3 of 12 positive, 3 + 4. All pos were on right side. 10% of tissue affected.
    Treatment Casodex/Lupron for 4 months, started Nov 12. Ex Beam Rad Ther Started Jan 1. High Dose Brachiotherapy started 3/12.
    Casodex/Lupron was to be for 6 months and I stopped early against Drs. orders.

  9. #19
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    I was diagnosed at 56 with a PSA of 6.8 and Gleason 3+4=7. I opted for low-dose brachytherapy, which they followed up with 25 days of lower-dose IMRT. 6 weeks after seeds (but before the IMRT) PSA was 0.9 and another month later was 0.1. Has not budged from 0.1 after about 6 other measurements. I'm now about 18 months post-seeds, still 0.1.

    I was advised of possibility of "bounce" but haven't seen it (yet). I did have rectal discomfort, moderately painful for a few months, then gradually lessening, and suddenly dropped off to none at about 12 months. Urination was still uncomfortable for about 7 or 8 months. Now it's not, but the stream is week.

    However, most of that is because I don't like taking the flow medications because they ALL give me backaches. As far as ED goes, like most of you it's not what it used to be, but I can still get erections. I alternate 5mg Tadalafil (generic Cialis) every other day with the flow medications.

    I was also told I probably would not ejaculate anymore, though would have "dry" orgasm. This has proved to be not true-- I still ejaculate, though of course nowhere near as much, and it's only seminal fluid (I'll take it, thanks). As for my choice of this treatment option, it was based on several factors:
    1. was not crazy about radical prostatectomy option. I'll just leave it at that.

    2. my insurance company (United Healthcare) flat-out said they will not pay for proton beam for P.C..
    I also had heard rectal problems are proving to be more frequent with that option, and more often being permanent. Though I personally know 3 guys who had it, and 2 are very satisfied. But coughing up $70k out-of-pocket was out of the question anyway. (Incidentally, though my urologist declined to offer an opinion on proton beam, after my course of treatment had begun, and while receiving 25 days of IMRT, the radiation techs weren't shy telling me their opinions).
    From research, I also got the vibe that there was a little bit too much "marketing" going on pushing proton beam. In any case, I'm not saying this to disparage anyone's choice of proton beam, just recounting my decision-making.

    3. The medical ctr I received treatment at here in Seattle has been doing brachytherapy for many years, so I knew they knew what they were doing, and have been perfecting it.

    They've also become much more focused with the IMRT than they used to be. One tech told me he'd been doing it for 15 yrs and when he thinks back to what they do now compared to what they used to do, it's a huge improvement. So I would suggest that anyone considering IMRT by itself not assume it just means "blast away".

    I actually first considered IMRT-only but changed my mind because the seeds option seems more focused. I have no complaints about that choice.

    I had significant urgency problems for about 3 months during which time I first used maxi pads, then mini pads, then graduated to flying without a net. (In my experience using Depends was way over-kill). My urologist told me at time of diagnosis that I was in a "sweet spot" of being a good candidate for basically whichever course of treatment I chose-- the main point being I needed to be comfortable with it in my own head. I'm lucky that there were many good choices available to me here.

    As for ED medication affordability, you may have seen another post where I detailed accessing tadalafil (generic Cialis) very cost-effectively from Canada-based internet pharmacies. This goes for generic Viagra too, obviously. I can't say enough about how satisfied I am with that option, as fighting with insurance companies to pay for ED drugs gets wearisome (as well as expensive). If you're interested, search on PharmacyChecker.com and go from there.

    Hope any of this is helpful.
    Jim in Seattle
    Last edited by Jim98122x; 01-28-2017 at 08:35 PM. Reason: white space added

  10. #20
    Moderator Top User HighlanderCFH's Avatar
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    Thanks for such a great post, Jim.

    Indeed, this will be very helpful for many patients just being diagnosed.
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Seven annual post-op exams 2012 through 2018: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

 

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