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

  1. #1
    Moderator Top User HighlanderCFH's Avatar
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    What I Need to Know About TWO TYPES of Brachytherapy

    Hi everyone,

    The new sticky regarding what people should know & ask about prior to undergoing surgery for prostate cancer will hopefully help new patients leaning in that direction -- or those who have already chosen it.

    For everyone who has undergone brachy treatments, perhaps you can list things to be aware of, questions to ask, etc., for those just starting down your road.

    If this thread proves to be helpful & informative, I'll make it a sticky also.

    Thanks,
    Chuck
    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. #2
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    That I would experience urinary frequency, urgency and poor flow for such a long time after bracchy.[ Now nearly 12 months]
    Flomax does help with the urine flow.
    I was probably expecting/hoping that my urinary function would return to somewhere near my pre bracchy normality.
    However, I am happy that I made the choice of bracchy.
    This has been my situation, others may have had a better outcome.
    Ask your specialists prior to your bracchy about realistic outcomes, I was more concerned with stopping the cancer than the after effects of the bracchy..

  3. #3
    Moderator Top User HighlanderCFH's Avatar
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    Sorry to hear you're still having some problems. Hopefully it will be getting better as time goes on.

    Good point in being mostly concerned with stopping the cancer. It sounds similar to what they told me about the 3 main goals before I had surgery:
    1- cancer control
    2- urinary function
    3- sexual function

    In any treatment form, including brachy and EBR, the absolute number one target is to make the patient cancer free.

    Good luck to you as your recovery continues,
    Chuck
    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.

  4. #4
    Senior User
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    106
    Always get a Second opinion, no mater what...

  5. #5
    Hello, I read your question and research and here is the information that I gather

    What Do I Need To Do To Get Ready for Brachytherapy?

    Around one month prior to you have the seeds put in your body, your radiation oncologist (a specialist who spends significant time in the treatment of individuals with malignancy) will make a treatment-arranging meeting arrangement. Amid this meeting, an uncommon method called a Trans Rectal Ultrasound (TRUS) will be utilized by your radiation oncologist to make nitty gritty photos of your prostate and growth. This ultrasound will be similar to the ultrasound you had for your prostate biopsy. Amid the ultrasound, a finger-like test is put in your rectum and pictures are taken of you're prostate. Ultrasound uses sound waves to make a photo of your prostate organ. The ultrasound pictures give your radiation oncologist data about the span of you're prostate, its shape, and the measure of your prostate tumor.

    Trans Rectal Ultrasound

    From the ultrasound pictures, your radiation oncologist will choose what number of seeds you require and precisely where to put them. They will likewise help your specialist pick the best kind of seed insert to treat your prostate malignancy. Your radiation oncologist may pick a low measurements rate (LDR) or high dosage rate (HDR). Low measurement rate seed inserts stay in your body. High measurement rate inserts are set in and around your prostate tumor for just a couple of minutes. The seed inserts are then taken out. The sort of seed insert you have and to what extent it stays in your body will rely on upon the measurements (or sum) of radiation you have to have the best treatment. Around a month after the arranging meeting, you will return to have the seeds put in.

    On the off chance that the ultrasound picture demonstrates that your prostate is too extensive, you may be given hormone treatment for two or three months prior to the seeds are embedded. The hormone treatment will recoil your prostate malignancy (See IMPACT handout, "Hormone Therapy and You," for more data). Hormone treatment is a prostate disease treatment, which brings down the measure of the male hormone, testosterone, in your body. Testosterone has been found to help your prostate disease cells develop. Your radiation oncologist will check the measure of your prostate two or three months after you have taken hormone treatment to check whether your prostate has become littler. This will help your radiation oncologist to choose the most ideal approach to put the seeds in you're prostate.

    Getting Ready for Brachytherapy

    1. What tests has your specialist let you know that you have to have before your seed insert?
    2. At the point when are your arrangements for these tests? List the day(s) and time(s) of your arrangements.
    3. Where do you have to go to have these tests? List the spots where you have to go for your tests.
    4. What transportation arrangements will you make to get to these spots? On the off chance that you need assistance, talk with your specialist or health care team.

    What Should I Do Before I Go to the Hospital?

    Your radiation oncologist will converse with you about the strides you have to take after to get prepared for your seed insert operation. The accompanying will give you a thought of a portion of the things you may need to do before you go to the healing center.

    Identify with your specialist or social insurance group about any solutions or herbs you are taking. Your specialist will let you know which meds you ought to quit taking or continue taking before your surgery. For instance: in the event that you are taking ibuprofen (meds like Motrin) or headache medicine, you may need to quit taking this pharmaceutical around 10 days prior to your seed insert. Make a rundown of your meds, the amount you take (the measurements or sum), and how frequently you take them. On the off chance that you need, you can bring the greater part of the medications that you take to a regular checkup so your specialist can see what you are taking. Make a point to enlighten your specialist concerning any drugs you are taking, even over-the counter medications (solutions you purchase without a medicine, for example, headache medicine, vitamins, or herbs before your surgery. Make a point to enlighten your specialist concerning any sensitivities you need to drugs.

    You ought to verify that you painstakingly clean your genital zone (the some piece of you body that incorporates your penis, scrotum, perineum, and butt) with an antibacterial cleanser one time every day for a few days prior to you go to the healing center. This will help bring down your possibility of getting a disease.

    Verify you know how to reach your specialist or human services group on the off chance that you have any inquiries or on the off chance that you have any crisis before or after your seed insert.

    The day preceding your surgery, you may have breakfast. When you eat and supper you might just have clear fluids. An unmistakable fluid is anything that you can see through like squeezed apple, 7-Up, stock, or water. Crystallize OŽ is additionally an unmistakable fluid.

    The day preceding your seed insert toward the evening you should take a diuretic. Your specialist will let you know what sort of diuretic to take. You can purchase this purgative at a nearby medication store. A diuretic is a drug you take that will bail vacant out your entrails.

    Try not to eat or beverage anything after 12 pm the night prior to your seed insert. On the off chance that you have drugs that you have to take, you can bring them with little tastes of water.

    Your specialist's office will let you know what time to be at the healing center. Before you go to the healing center in the morning, you should take a purification.

    Your specialist's office will let you know what sort of douche to utilize. You can by the douche at your nearby medication store. A purification is a straightforward approach to wipe out your gut. A little compartment of liquid is pressed into your guts through your rear-end. Take after the headings that accompany the douche. On the off chance that you have any inquiries concerning how to utilize the purification, talk with your specialist or social insurance group. The eating routine, diuretic, and douche are critical in light of the fact that your inside must be spotless before you get your seed insert.

    This makes it much simpler for your specialist to see you're prostate. Twofold check with your specialist about what time you have to take the purgative and the bowel purge. You will need to anticipate a relative or companion to help you for a few days when you go home. Your specialist will verify you are prepared to leave the doctor's facility after your seed insert. You ought to feel well and have the capacity to begin doing ordinary exercises in around three days. You ought to have the capacity to come back to work three to five days after your seed insert. In the event that you are working, you ought to talk with your administrator about setting aside time off work for your seed insert. You might likewise need to get a specialist's note before you can come back to work. Keep in mind to talk with your specialist or human services group about this.

    Arranging Before You Have Your Seed Implant

    1. What food would you say you are going to eat before your surgery?
    2. At the point when do you have to take your diuretic and douche?
    3. Why should going help you when you return home from the doctor's facility? Record their name(s) and telephone numbers:
    4. What solutions would you say you are taking?
    5. Do you have any sensitivities that you have to inform your specialist concerning?
    6. At the point when do you have to wash your genital territory? What will you utilize?

  6. #6
    I had a combination of high-dose brachytherapy and external beam radiation (IMRT) at the Moffitt Cancer Center in Tampa, FL. Moffitt is part of the National Cancer Institute and is also a research institution. Rated highly on a national scale.

    My understanding is that this combo approach is only used in some centers in the US and used more widely in Europe. I had two HDR brachytherapy procedures and five weeks of IMRT on a daily basis.

    Unlike permanent seeds, in HDR brachytherapy, they insert the seeds into the prostate for only about 15 minutes and then remove them. It requires general anesthesia. In my case, they placed a "spacer" made of a dissolvable material between the prostate and the rectum to minimize side effects to the rectum.

    My side effects were mainly urinary (frequency as well as retention after the 2nd HDR procedure). I needed a catheter for a few days after the 2nd procedure but most of my side effects were gone after two weeks. I had little in the way of side effects from the IMRT besides being tired for about a month afterwards.

    Note that I was given tamsulosin to improve urinary flow which worked very well. It's been a year since my treatment. I get monitored for PSA every three months. I am still taking the tamsulosin although at a lower dose.

    I thought the HDR brachytherapy plus IMRT went well as long as it works! The protocol did not call for ADT.
    Last edited by HighlanderCFH; 02-06-2016 at 09:29 PM. Reason: added white space
    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. #7
    Moderator Top User HighlanderCFH's Avatar
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    An interesting treatment plan, Mark. Please let us know how things go.

    And welcome to the forum.
    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.

  8. #8
    Experienced User
    Join Date
    Feb 2016
    Posts
    86
    Hi Guys:

    I will be meeting with a Standford oncologist who offers the HDR Brachy as a stand-alone treatment option for low-to-intermediate risk patients (at least I think he does!). I will report back when I know more...and if anyone has had the HDR Brachy ( 2treatments?) without the IMRT, please weigh in!

    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.

  9. #9
    Experienced User
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    Hi Folks:

    I posted this info under another thread called High Dose Brachy & CyberKnife, but wanted to post it here as well for maximum visibility for anyone considering radiation treatments. There is another form of Brachy which is not the seed implants that may be an appropriate treatment option for low-risk and some intermediate risk patients that is worth looking into.

    In my research on High Dose Brachytherapy (monotherapy) and CyberKnife, I stumbled across another forum that includes a great discussion of these techniques along with a thorough discussion and input input from guys who chose surgery vs. these other options. I was having trouble finding very many on this forum who had experience with these HD Brachy and could relate their real world experience. It also led me to some great data on the UCLA on comparing outcomes.

    I think both are worth checking out for anyone still weighing options. Results are VERY encouraging IMO with quite comparable cure rates to surgery without some of the nastier side effects. Radiation therapy (like surgical options) has come a long way and I am really looking forward to talking to the radiation oncologist at Stanford on Monday about this treatment.

    http://urology.ucla.edu/body.cfm?id=447
    Last edited by Lumore51; 02-28-2016 at 12:14 AM.
    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.

  10. #10
    Regular User
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    Well this is a thread I will be following. I start hormone therapy next week for an undetermined length of time, a break then 25 EBRT, break then permanent seed implants. I have not asked yet whether it will be HD or LD, bu I am assuming LD. I am not sure if the decision has been made. I am classified at High Risk but no apparent near gland invasion and was told no lymph nodes invasion, all per MRI. There was extraprostatic extension and I guess thats why I am high risk. From what I understand there is a yet to be validated Canadian study that the protocol I outlined is showing very good results. I have been advised on the brachy side affects and will prepare as we move forward. Thanks to all that posted, I will report back when I get to that stage

 

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