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

  1. #21
    Regular User
    Join Date
    Jan 2017
    Posts
    27
    Looks like my previous post disappeared while I was trying to edit it, so I'll post again.

    I am 18 months post treatment of my prostate cancer by brachytherapy followed up by 25 days of lower-dose IMRT.
    Dignosed at 57 yrs old. History of prostate cancer in familiarly (father).
    Pre-treatment PSA= 6.8 with Gleason 3+4=7
    30 days post-seeds/pre-IMRT, PSA=0.9
    10 weeks post-seeds and mid-IMRT PSA=0.1
    Every PSA since up till present, 1.5 yrs later, PSA=0.1

    Reasons I chose brachytherapy (whether well-informed or not-- this was my thinking.)

    1. I was never OK with total prostatectomy. My concern focused on potential for incontinence and impotence. (admittedly a possibility with any treatment choice). I just was not comfortable with this option. I know it's good for lots of guys, just wasn't for me.

    2. Insurance company (United Healthcare) flat out says "we won't pay for Proton Beam for prostate cancer". Reference HERE, by the way. This was end of story for me. But, I was reaching that decision myself anyway after research. I was getting the feeling it was a little too heavily marketed and pushed for profit, as opposed to being demonstrably better than other options. Had also read reports about possible increased incidence of side effects such as rectal discomfort, more often permanent, compared to other options. Data isn't too plentiful in this area, from what I saw at the time. As a treatment it may have improved in the last year or two. In any case, I became less comfortable with the option, and my insurance refusing to pay for it sealed the deal.

    3. My preferred treatment center, Swedish Cancer Institute/Seattle has been big on brachytherapy for years so I knew they knew what they were doing. Was referred to an oncologist I liked who offered both IMRT-only, as well as brachytherapy. Though initially I thought I preferred IMRT-only, I was sold on the combination of seeds+IMRT. I felt the seeds offered superior localization compared to all-IMRT.

    The procedure itself wasn't bad. Fortunately I had a very good friend accompany me in the AM, drive me to the hospital, wait for me, and drive me home. I 102 seeds of Palladium-103 implanted. Surgery was completed in half a morning. Had catheter removed in recover room, and went home. Was up, awake, and alert on my couch by early afternoon. Totally out-patient.

    Next day I had extensive bruising under scrotum. I had significant discomfort peeing for a month or two, occasionally rough days of rectal discomfort in the first month or two. These tapered off in the first couple of months. Oncologist did provide pain relieve. Peeing was uncomfortable for about 7 or 8 months, progressively less so. At about 12 months, the occasional rectal discomfort abruptly stopped entirely. Urgency was a problem for a few months, and at 18 months still occasionally is. The biggest problem with this for me to get used to, is to develop the habit of pro-actively using the bathroom before going anywhere even with I don't have to. It's a hard habit to get into, using the bathroom when you don't have to. But it helps. In my experience, garments like Depends would have been big overkill. I just used common maxi-pads then mini-pads, then nothing. One large box bought at Costco the day after my surgery lasted me till I didn't need them anymore.

    I also would recommend buying an add-on bidet seat for your toilet, with warm water attachment. They are cheap, and they can be a lifesaver if you experience rectal discomfort due to radiation. I didn't figure this out until after my discomfort was mostly over, but it's well worth the $50-75 they cost. They are very easy to install.

    Performance-- well, let's be real--t's not like it used to be, but it's OK. Though I had been told I'd probably only have dry orgasms (and not ejaculate) anymore, this has proved not true. I can still ejaculate seminal fluid (the clear stuff). Not as much of course (I used to be a big producer ), but it's better than nothing.

    As for ED, like for many others, this has been an occasional problem, though possibly not as much for me as for some who were diagnosed older then me. Cialis has been helpful. My insurance company refused to pay for it, even with a letter of medical necessity from my doctor's office, so I investigated Canada-based internet pharmacies, and have been really satisfied with that. (with my Urologist's enthusiastic blessing, by the way). If you're having trouble with the ridiculous cost of Cialis or Viagra, check out PharmacyChecker.com for some reputable pharmacies. You will need a prescription but your doctor will certainly write you one. (if you're worried, just don't tell him you're using an internet pharmacy). As I said, my Urologist is all for it. I've purchased from several pharmacies on PharmacyChecker and never been disappointed with quality, or been ripped off. I buy 10mg generic Tadalafil (Cialis) and split into x2 5mg pills. This comes out cheaper by a lot than buying 5mg pills.

    Overall I'm very satisfied with the choices I made. A week before my treatment was over, a friend confided that he'd been diagnosed too. Other options didn't appeal to him either, so I referred him to my Oncologist. He had just as good an outcome as I did-- actually with fewer urgency issues than me. So he's a happy camper too.

    So for brachytherapy, overall for me, I'd give it a thumbs-up. I'd rate it a 92, it's got a good beat, and you can dance to it.
    (oldtimer's joke).

  2. #22
    I wanted to update my situation from my earlier post in this thread. Briefly, I was treated in February 2015 with a combination of HDR brachytherapy and 25 sessions of IMRT. So it's been nearly two years since I finished treatment and things are good. My PSA has steady gone down although did bounce and was a source of anxiety to say the least. My main side effect is urinary urgency which I experience maybe one out ten times I need to urinate. I did not have this prior to treatment so it must have something to do with the treatment. My ED has also steadily gotten worse over the intervening two years. Still, I am glad I chose the radiation route and go back for another PSA test in six months. If anyone has specific questions about the procedures or the early side effects, I'd be glad to respond.
    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

  3. #23
    Experienced User
    Join Date
    May 2012
    Posts
    78
    Hi Mark, did you have three gold markers inserted in your prostate?
    What type of IMRT? Was is VMAT?
    How did the IMRT target your prostate, gold markers or tattoos or......?

    Thanks,
    MP
    Age 59 in 2013.
    PSA - 2003=1.5, 2005=1.3, 2007=1.9, 2008=1.8, 2010=2.3, March 2012=3.1, May 2012=3.35, May 2012=3.6. Three different Labs/Assays.

    Bx-Dx - August 2012=3 out of 14 cores - all G6 (USC and City of Hope Path). Follow AS

    After Dx - Three months PSA - Oct 26 2012=2.5 (down from 3.6), Nov 6 2012=3.16 - New Lab at USC, Nov 14 2012=2.1(down from 2.3)
    Six months PSA - Feb 07 2013 3.29 (up from 3.16)

  4. #24
    Experienced User
    Join Date
    Feb 2016
    Posts
    86
    Hi guys:

    I haven't been active for awhile, but I committed to Chuck to provide an update to anyone who is interested in HD Brachytherapy as a Monotherapy since I was the one that brought to his attention that most posts about RT did not include this option-generally, when RT is mentioned on this forum, it's usually EBRT or Brachy seeds. This treatment is NOT seeds, but rather 2 brief sessions 2 weeks apart of high dose, targeted radiation therapy, where they insert a series of hollow tubes into the prostate during the procedure to deliver the radiation exactly where they want it based on MRI imaging. You are under anesthesia for this, and go home the evening the procedure(s) are performed. This is the treatment I chose for my PC. The procedure was performed at Stanford by Dr. Buyyonouski and his team. I am now exactly one year out from the final treatment, and if I was pleased by that choice at the time, I am even more so now.

    My initial PSA was 7, Gleason 6's and 7's (3+4). You can see all the details in my signature. I had been under active surveillance for about 9 months after the initial biopsy found the cancer. I had an MRI guided biopsy which found more, and higher grade cancer, and that's when I began looking at treatment. At first, I thought I was a shoo-in for surgery. I wanted that shit OUT. But then I got very spooked by possible side effects, and my brilliant wife started researching options and that's how we ended up at Stanford. You can read my details of my treatment in the thread called HD Brachy Monotherapy, my choice & my experience.

    It is often quoted on this forum that the primary treatment goals are: 1. Get rid of the cancer. 2. Retain continence and 3. Be able to still get an erection! I will address how all three in terms of my treatment.

    1) No way to know if they got all the cancer, but I have very high confidence that they did. Dr. B and his team spent a huge amount of time talking me about how it works, and providing a TON of very comforting research on this. I often see posted here that with surgery, the "hit" is upfront, then one gradually recovers (most of the time), and with RT, the hit comes later, perhaps years down the road. I will go so far as to say that my understanding is that not only is this procedure equal in terms of curative effect (biochemical control rates) to surgery or other forms of RT, it in fact may be superior with FAR FEWER SIDE EFFECTS because it is so targeted. There is sound scientific evidence to support that this claim. They have been doing this and refining it for over 15 years. I'll post a couple of links, but if for some reason they are not the kind allowed on the forum, please PM and I will get them to you.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003433/
    https://prostatecancerinfolink.net/2...-year-results/

    2) Absolutely NO incontinence of any kind-EVER. Difficulty urinating for a few days post-treatment until I passed some clots, but then perfect. I do still take Flomax as a hedge.

    3) No ED to speak of. Prior to the diagnosis, I had been considering taking Viagra when I wanted to ensure stellar performance. I just assumed that was a function of getting older. For about 2-3 months after the treatment, I did need Cialis or Vitamin V in order to maintain an erection. Now, that isn't necessary (especially for daytime sex), but I will pop a 1/2 or 1/4 cialis or V most times if I plan to be romantic. I still ejaculate, but less. Quality of orgasm is still great.

    It seems that the main reason a lot of guys feel better with a surgical option is becasue the extent of the cancer can be seen in the path report and some knowledge of margins can be gained-and it is true that this treatment cannot give you that info. So far, my PSA history has been from 7 to 2.45 at 3 month follow up, then 1.54 at 6 months to 1.46 at 10 months out. I am due for another test soon, but it is trending the right way (and I've been told that even a few "bounces" are normal and not to be concerned about unless a pattern emerges. In fact, Dr. B's nurse said that there is some research that indicates that a few bounces before stabilizing after RT can be indicative of a longer term survival rate...).

    I realize that this info may not be helpful to guys that have already gone under the knife or a different form of RT. My treatment is newer relatively speaking, but has great 10 year data and can be an excellent choice for guys up to "Intermediate risk" (and newer research even included high risk) categories-which many fall into on this forum. There is lots of data out there on this...the only "drawback" is that it is currently only performed at Academic Centers: UCLA, Stanford and UCSF on the West coast, not sure of where in other regions but assume that would easy enough to find out. There is another user on the forum (SV Golfer) who underwent this several years ago, had a number of bounces and seems to be doing well. I encourage anyone looking for options outside of surgery or seeds to look into HD Brachy as a monotherapy and consider if it might be the correct choice for you. I'm so glad that I did!
    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. #25
    Akai,

    Sorry it took me so long to find your post.

    I believe I did have three gold markers inserted into the prostate. However, I remember receiving two "tattoos" as well. I received 25 sessions of IMRT/IGRT after two brachytherapy procedures. Total radiation for the external beam radiation was 4500 cGy and 180 cGy per fraction. I'm unfamiliar with the term VMAT.

    I hope this helps.

    Mark
    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

  6. #26
    Lumore51 thanks, I am strongly considering this mono treatment, HD BT. How are things going for you now? Denis
    65 YO healthy man
    PSA had been 4.1/2 for a couple of years,
    PSA 5/1/17 4.6,
    Multiparametric MRI, 5/15/17 showed lesion
    13 core needle biopsy 3 cores positive 3+3 and one positive in the lesion, may be overlap
    All cores less than 30%
    8/22/17 - second opinion pathology shows a small amount of (3+4) in one core, < 5%, ordered decipher to inform next steps
    9/27/17 -Decipher test shows intermediate risk so now exploring treatment options.
    2/6/18 - completed HDR BT
    5/3/18 Post HDR BT PSA 1.3
    9/18/18 PSA 1.2
    4/1/19 PSA 1.0 Testosterone 475
    Thanks, Denis
    "One day at a time"

  7. #27
    Experienced User
    Join Date
    Feb 2016
    Posts
    86
    SubDenis,

    I a nutshell, I am doing great! No side effects others than those previously noted-all short-lived and very early on and have either resolved completely (urinary) or totally manageable (mild ED) with 1/2 cialis or Viagra which I don't always need. PSA continues to drop. No regrets!

    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. #28
    Thanks, I am probably doing HDR BT as my treatment, our numbers are similiar. I most like the ease of the procedure. Thanks, for sharing. Denis
    65 YO healthy man
    PSA had been 4.1/2 for a couple of years,
    PSA 5/1/17 4.6,
    Multiparametric MRI, 5/15/17 showed lesion
    13 core needle biopsy 3 cores positive 3+3 and one positive in the lesion, may be overlap
    All cores less than 30%
    8/22/17 - second opinion pathology shows a small amount of (3+4) in one core, < 5%, ordered decipher to inform next steps
    9/27/17 -Decipher test shows intermediate risk so now exploring treatment options.
    2/6/18 - completed HDR BT
    5/3/18 Post HDR BT PSA 1.3
    9/18/18 PSA 1.2
    4/1/19 PSA 1.0 Testosterone 475
    Thanks, Denis
    "One day at a time"

  9. #29
    Top User
    Join Date
    Aug 2016
    Posts
    1,708
    Quote Originally Posted by Lumore51 View Post
    Hi guys:

    I haven't been active for awhile, but I committed to Chuck to provide an update to anyone who is interested in HD Brachytherapy as a Monotherapy since I was the one that brought to his attention that most posts about RT did not include this option-generally, when RT is mentioned on this forum, it's usually EBRT or Brachy seeds. This treatment is NOT seeds, but rather 2 brief sessions 2 weeks apart of high dose, targeted radiation therapy, where they insert a series of hollow tubes into the prostate during the procedure to deliver the radiation exactly where they want it based on MRI imaging. You are under anesthesia for this, and go home the evening the procedure(s) are performed. This is the treatment I chose for my PC. The procedure was performed at Stanford by Dr. Buyyonouski and his team. I am now exactly one year out from the final treatment, and if I was pleased by that choice at the time, I am even more so now.

    My initial PSA was 7, Gleason 6's and 7's (3+4). You can see all the details in my signature. I had been under active surveillance for about 9 months after the initial biopsy found the cancer. I had an MRI guided biopsy which found more, and higher grade cancer, and that's when I began looking at treatment. At first, I thought I was a shoo-in for surgery. I wanted that shit OUT. But then I got very spooked by possible side effects, and my brilliant wife started researching options and that's how we ended up at Stanford. You can read my details of my treatment in the thread called HD Brachy Monotherapy, my choice & my experience.

    It is often quoted on this forum that the primary treatment goals are: 1. Get rid of the cancer. 2. Retain continence and 3. Be able to still get an erection! I will address how all three in terms of my treatment.

    1) No way to know if they got all the cancer, but I have very high confidence that they did. Dr. B and his team spent a huge amount of time talking me about how it works, and providing a TON of very comforting research on this. I often see posted here that with surgery, the "hit" is upfront, then one gradually recovers (most of the time), and with RT, the hit comes later, perhaps years down the road. I will go so far as to say that my understanding is that not only is this procedure equal in terms of curative effect (biochemical control rates) to surgery or other forms of RT, it in fact may be superior with FAR FEWER SIDE EFFECTS because it is so targeted. There is sound scientific evidence to support that this claim. They have been doing this and refining it for over 15 years. I'll post a couple of links, but if for some reason they are not the kind allowed on the forum, please PM and I will get them to you.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003433/
    https://prostatecancerinfolink.net/2...-year-results/

    2) Absolutely NO incontinence of any kind-EVER. Difficulty urinating for a few days post-treatment until I passed some clots, but then perfect. I do still take Flomax as a hedge.

    3) No ED to speak of. Prior to the diagnosis, I had been considering taking Viagra when I wanted to ensure stellar performance. I just assumed that was a function of getting older. For about 2-3 months after the treatment, I did need Cialis or Vitamin V in order to maintain an erection. Now, that isn't necessary (especially for daytime sex), but I will pop a 1/2 or 1/4 cialis or V most times if I plan to be romantic. I still ejaculate, but less. Quality of orgasm is still great.

    It seems that the main reason a lot of guys feel better with a surgical option is becasue the extent of the cancer can be seen in the path report and some knowledge of margins can be gained-and it is true that this treatment cannot give you that info. So far, my PSA history has been from 7 to 2.45 at 3 month follow up, then 1.54 at 6 months to 1.46 at 10 months out. I am due for another test soon, but it is trending the right way (and I've been told that even a few "bounces" are normal and not to be concerned about unless a pattern emerges. In fact, Dr. B's nurse said that there is some research that indicates that a few bounces before stabilizing after RT can be indicative of a longer term survival rate...).

    I realize that this info may not be helpful to guys that have already gone under the knife or a different form of RT. My treatment is newer relatively speaking, but has great 10 year data and can be an excellent choice for guys up to "Intermediate risk" (and newer research even included high risk) categories-which many fall into on this forum. There is lots of data out there on this...the only "drawback" is that it is currently only performed at Academic Centers: UCLA, Stanford and UCSF on the West coast, not sure of where in other regions but assume that would easy enough to find out. There is another user on the forum (SV Golfer) who underwent this several years ago, had a number of bounces and seems to be doing well. I encourage anyone looking for options outside of surgery or seeds to look into HD Brachy as a monotherapy and consider if it might be the correct choice for you. I'm so glad that I did!
    Speaking for myself about the main reasons I chose surgery over radiation, I had two considerations. With a high expectation the cancer was confined to the prostate I wanted it removed as cleanly as possible, and I wanted to avoid long term side effects.

    I have no long term side effects from the surgery, no incontinence, no ED. Everything recovered; continence in 3 months, erections in 15 months, and I am free of concerns about the long term side effects of radiation.

    It is true the pathology report is useful and reassuring in confirming the extent of my cancer to the highest degree possible, but this is after the fact and not the reason (much less the main reason) I chose surgery. I chose surgery because in my profile it had the highest probability of "curing" my cancer with no long term side effects.

    It is my opinion, at this time, that one form of treatment is not proven universally superior to another. Brachytherapy itself is an improvement to the older radioactive seeds therapy. Why there are so many forms of treatment for this disease is because there are so many patient profiles to this disease. The variables of this disease and patient profiles drive the treatment options, imo, and that's a good thing.

    Either way it's still a gamble because we are choosing based on statistics that are still far from certainty.
    Last edited by Another; 12-10-2017 at 02:03 PM.

  10. #30
    I was told by different independent sources, that if you are interested in brachytherapy, they have a world class facility in this modality in Wheeling, WV of all places.

    By all means, don't take my word for it and check it out for yourself if you are considering the seeds treatment, but there are a lot of capable experts outside of the typical citadels of medical understanding.

    Makes sense, too, places like Johns Hopkins are graduating new doctors and residents all the time, and they all don't stay in Maryland or wherever.
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3, PSA test 7/2019 2.0


    DOB 1956, in Pittsburgh, USA

 

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