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

  1. #41
    Regular User
    Join Date
    Aug 2016
    Posts
    47
    Quote Originally Posted by Bulldog View Post
    A question for you all:

    SITUATION: 1. LDR seed implantation schedule for July 30 and follow up visit July 31st with RO. Had 28 Days of IMRT..Last day is this Monday-tx 28th-!

    QUESTION: 1. I was informed that my Urologist will be participating with his procedure- WHY-?

    Thank you for your support during this journey.

    This fourum has been an incredible resource and comfort.

    Bulldog
    Hi Bulldog. Thank you for the best wishes.

    From the Cleveland Clinic website:

    What happens during the procedure?

    The entire procedure takes about 90 minutes. Most patients go home the same day.

    A radiation oncologist and urologist perform the procedure. Both doctors are actively involved in all aspects of the implantation, from the planning to the post-operative care. During the procedure, the urologist provides ultrasound guidance and the radiation oncologist places the radioactive seeds. The prostate ultrasound and treatment planning are both done at the same time as implantation of the radioactive seeds
    .

    https://my.clevelandclinic.org/healt...cedure-details

    All the best.
    Biopsy 7/16 (50 Yrs. 6-1, 235lbs at the time of biopsy)
    20 Cores: 5 positive
    Left Side:
    Lat Base: small focus of atypical glands
    Lat Mid: 3+4 2 of 2 cores (discontinuous 25%, 20% 3.5mm, 3mm)
    Apex : 4+3 1 of 3 cores (30%; 3mm)
    Base : 3+4 1 of 1 cores (70%; 9 mm)
    Mid : 3+3 1 of 2 cores (50%; 3mm)

    Right side : All cores benign

    DRE: 30 gm prostate without nodules; Hypoechoic areas: none
    Measurements: 2.4 x 4.5 x 3.4cm Tz measurements: 1.7 x 2.4 x 2.7cm
    Vol: 19 cc Tz volume: 6 cc
    Density: 0.17 ng/ml/cc
    Boundaries of the prostate and seminal vesicles were: normal

    PSA 06/10 0.74; 4/15 1.26; 5/16 3.72; 6/16 3.15 Free 13% 4K score 8% 9/16 PSA 3.51

    1/31/17 PSA 3.07 Low Dose Brachy at Cleveland Clinic. 90 seeds.
    8/17: PSA 0.45
    2/18: 0.37
    5/18: 0.28
    8/22/18 0.30 (19 mo.)
    11/22/18 0.60 (22 mo.)
    5/23/19 0.39 (28 mo. FlowMax, Vesicare)

  2. #42
    Newbie Regular User
    Join Date
    Jul 2018
    Posts
    15
    I am 99% sure that HDR Brachytherapy is right for me. I am looking for a doctor that has over 500 procedures under his belt and that is nationally recognized in this area. I would appreciate recommendations. I live in Nashville, TN but I am certainly open to travel. Thanks!
    Age 58, White, Athletic Build - not obese but above BMI for height
    T1c (diagnosed June 22, 2018 following June 15, 2018 Biopsy)
    Gleason 3+3=6 (Grade Group 1)
    PSA 5.8
    History of Prostate Cancer (Father) - surgery 20 years ago on low grade cancer, cancer free
    Total % of Cancer = 10%
    Total Length of Cancer = 16mm
    Cores = 3/12
    Left Lateral Apex 3+3=6, 1 Core, 60%, 8mm
    Left Mid 3+3=6, 1 Core, 5%, 1mm
    Left Apex 3+3=6, 1 Core, 70%, 7mm
    Longest Tumor in Single Core = 8mm
    Max % of Core Involvement = 70%
    # of Cores with >50% involvement = 2
    No Symptoms: Biopsy done due to PSA rising annually and family history (2016 = PSA 2.5, 2017 = PSA 3.5, 2018 = PSA 4.5 - testing by GP at annual physical - 2018 Ur PSA taken 1 day after 4.5 PSA showed 5.8, so I believe someone's measurement was off)

  3. #43
    Dr. Jeff Demanes in CA is the pioneer of HDR-BT.

    The specialist that Denis used is also very highly regarded. He might be closer for you.

    https://pcnrv.blogspot.com/2016/08/h...hdrbt.html?m=1

    BTW, I watched Denis’ decision process last year with both impatience and fascination, as he is highly intelligent and curious. Kept going back and forth on surgery. And, suddenly the choice was clear...for HDR-BT. You are wise to follow his experience and advice.
    DOB: May 1944
    In Active Surveillance program at Johns Hopkins
    Strict protocol of tests, including PHI, DRE, MRI, and biopsy.
    Six biopsies from 2009 to 2019. Numbers 1, 2, and 5 were negative. Numbers 3,4, and 6 were positive with 5% Gleason(3+3) found. Last one was Precision Point transperineal.
    PSA has varied up and down from 3 to 10 over the years. Is 4.0 as of September 2019.
    Hopefully, I can remain untreated. So far, so good.

  4. #44
    Newbie Regular User
    Join Date
    Jul 2018
    Posts
    15
    Quote Originally Posted by ASAdvocate View Post
    Dr. Jeff Demanes in CA is the pioneer of HDR-BT.

    The specialist that Denis used is also very highly regarded. He might be closer for you.

    https://pcnrv.blogspot.com/2016/08/h...hdrbt.html?m=1

    BTW, I watched Denis’ decision process last year with both impatience and fascination, as he is highly intelligent and curious. Kept going back and forth on surgery. And, suddenly the choice was clear...for HDR-BT. You are wise to follow his experience and advice.
    His knowledge and how he pursued decision making has been my greatest help! But all of you gentlemen have been great. I will be reaching out to him.
    Age 58, White, Athletic Build - not obese but above BMI for height
    T1c (diagnosed June 22, 2018 following June 15, 2018 Biopsy)
    Gleason 3+3=6 (Grade Group 1)
    PSA 5.8
    History of Prostate Cancer (Father) - surgery 20 years ago on low grade cancer, cancer free
    Total % of Cancer = 10%
    Total Length of Cancer = 16mm
    Cores = 3/12
    Left Lateral Apex 3+3=6, 1 Core, 60%, 8mm
    Left Mid 3+3=6, 1 Core, 5%, 1mm
    Left Apex 3+3=6, 1 Core, 70%, 7mm
    Longest Tumor in Single Core = 8mm
    Max % of Core Involvement = 70%
    # of Cores with >50% involvement = 2
    No Symptoms: Biopsy done due to PSA rising annually and family history (2016 = PSA 2.5, 2017 = PSA 3.5, 2018 = PSA 4.5 - testing by GP at annual physical - 2018 Ur PSA taken 1 day after 4.5 PSA showed 5.8, so I believe someone's measurement was off)

  5. #45
    For those interested in HD Brachy, I've added four recent papers on it in the Subforum, Thread(H), #36-39. #38 is a review of it in various settings.
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg., then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%, 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018 (?)
    09-26-18 (13 m) 0.013 (30-day retest)
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015
    08-28-19 (2 yr. ) 0.016
    Avg. = 0.013

  6. #46
    HDR continues to be a good choice for me. If I can help anyone understand what I went though please let me know 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 a 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
    10/28/19 PSA 0.4 Testosterone 524
    Thanks, Denis
    "One day at a time"

  7. #47
    Experienced User
    Join Date
    Feb 2016
    Posts
    86
    Hi Searcher:

    I too underwent HD-BRT about 2.5 years ago. You can read about my experience by searching under my username. Please feel free to reach out to me as well. I couldn't have made a better decision and encourage more to consider this therapy.

    Best of luck!
    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. #48
    Regular User
    Join Date
    Jan 2018
    Posts
    37
    Good morning,

    This is an update and to alleviate any prostate cancer member's concern about LDR BRACHYTHERAPY:

    1. Had 28 Days of EBRT and had a 3 week wait before LDR.
    2. Had LDR BRACHYTHERAPY 07.30.18.
    Had 72 seeds implantation.
    3. This is a very patient friendly procedurw:
    A. You are under general anaesthesia
    B. You are sore at the insertion site
    Ice and Advil makes this very manageable.
    C. Some burning pain urination and cramping for the first day.
    D. Up every 2hrs to pee at night.

    Please get your PSA done and treat your cancer early.
    LDR Brachytherapy is a great option

    God Bless

    Bulldog

  9. #49
    Regular User
    Join Date
    Jan 2018
    Posts
    37
    UPDATE POST LDR on 07.30.18:

    Today, I had my follow up visit with my urologist. This was also my 3rd ADT shot.
    Present status:
    1. PSA is 0.27.
    *Very happy with this.
    2. Issues at times with delay in urination.
    *URO says this is excepted and I will be inflamed for the next 2 months. I will stay on Flomax 0.4 twice a day.
    3. Fatigue.
    *As excepted between the ADT and up every 2 hours to per.
    *I will stay on ADT until July 2019.

    This is all manageable.
    LDR is an excllent tx option.

    Please donot wait on your PSA.
    If I would of acted sooner, all that would of been need was LDR.

    God Bless

    Bulldog

  10. #50
    I am glad I chose HDR. I am 18 months post and PSA is 1.0 and all systems are normal. My routine took about 6 hours all total each day. I did have a problem in the second session and went home with cath but it came out the next day. I wish you well. 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 a 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
    10/28/19 PSA 0.4 Testosterone 524
    Thanks, Denis
    "One day at a time"

 

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