Question(s) about bracytherapy

My husband who is currently 71 was diagnosed with PC in November of 2009. While his PSA was only 2.8 and the DRE was normal, the biopsy showed that of 10 samples taken, four were cancerous, one was suspicious and one was spoiled. The Gleason number was 6 (3+3) and no definite stage was given other than either T1 or T2.

Since that time, he has had an appointment with an oncologist recommended by the urologist. During that app't (which I was unable to attend), all the treatment options were laid out and he was told that there was lots of time to make a decision. Fast forward to late February when his PSA jumped a full point to 3.85 - still not that high, but a definite jump from the previous November. Added to the mix is the fact that his dad died at 65 years of age from a combination of prostate and lung cancers.

Here comes my question (if you're still reading ): My husband and I decided that brachytherapy is the best option as it is the least invasive and most successful (?). In reading the material about this, he was advised to stay away from young children and pregnant women once the procedure was finished. If this is the case, what horrible things are going to happen in his body ??

Any input would be most appeciated.

Dear afterglo:

Sorry you have to be here and we will help if we can.  The issue with pregnant women and infants is precautionary.  I think if you read the precautions carefully you will see that the docs are not saying "stay away" rather they are saying no extended close contact for a period of time.  That period ranges from weeks to a few months depending on the half life of the isotope used.  The most likely thing that the seeds will be doing to your husband's body is that they will be killing the cancer.

Based on your husband's stats as you have presented them he would seem like a fine candidate for brachytherapy.  The cure rate is equal to surgery but the procedure is considerably less invasive with a liklihood of less severe side effects.  I admit to being biased in favor of thie treatment...I looked at all of the options and chose this one.

As David said, I am doing great post-procedure with zero SE's.  JohnT is pretty much the same as are several brachytherapy patients who post less frequently on this forum.  Please feel free to click the link at the bottom of my signature if you would like some detail on my "journey".  Also, feel free to come back with any questions with which I might be helpful.

Good luck and let us know how you progress,

Tudpock

Your husband doesn’t have much to worry about in terms of avoiding pregnant women and small children. Here’s why. First, radiation follows what physicists call the “inverse square law” which simply means that the radiation decreases very fast as the distance increases. For example, the radiation 12 inches away from your husband’s seeds will be one quarter of what it is at 6 inches. So, not getting close means staying two or three feet away at the most. Second, radiation effect depends on exposure time. Just walking past a pregnant woman is a very short exposure time. Finally, the material used in the seeds has a short half-life. For example, iodine seeds have a half-life of about 60 days, which is to say that after 60 days they emit half as much radiation as they did when they were implanted. Or looking at it in terms of distance, someone who had to stay two feet away just after you got the seeds only has to stand one foot away after two months. Some of the newer seeds use materials with a shorter half-life, such as 14 days. So the time period in which he MIGHT present a risk is shortened.

Myself I don't understand why alot more men don't go this route as to usually much better scenarios on side effects and possibly less e.d. and shows excellent cure rates or similar rates to surgeries and others. But you need to go docs with great track records, you don't want Joe Newbie doing this kind of work. Don Cooley had once posted a case on his website of a Newbie brachy doc whom put a brachy seed into a patient's seminal vessical with some complications thereafter...qualifications are most important on any treatment chosen. Some experts in this are: Dattoli (Florida), RCOG (Radio Therapy Clinics of Georgia), and some others you can find out about. There alot of docs now doing this, so locally you probably have someone...find out how many proceedures or how much experience they have. It is not as scary as you believe. You can read about this proceedure in Dr. Strums book- A Primer on Prostate Cancer.

Tudpock 18, a million thanks for documenting your journey so precisely. From reading your diary (and printing a copy ), I have even more questions to ask.

Even though we are almost 4 months into ours, my hubby is still in denial and really wants me to make the decisions as I'm the one doing the research. He says that 'he just wants it over'. While I can appreciate his thinking, I'd prefer working as a team as you and your wife did.

I really think that having his biopsy done with absolutely NO sedation traumatized him. We were told that that hospital always does it this way. WHY??? The things you learn as you go through something like this are beyond amazing .

                              ************************

Just one more thing, how do I post his stats to avoid repeating them with every entry?

To get his data in your replies, just go to the Control Panel, then Edit Profile, and finally put the info in the Signature.

Bill

Hi afterglo:

I'm glad my info was helpful.  I see that Bill has told you how to update your signature and that would be a good idea if you could take the time to do that.  I hear what you are saying about the trauma from the biopsy.  For some men that's a big deal and for some it's a piece of cake.  I had IV sedation (as you saw in my story) so it was ok for me.

I would encourage you to get hubby's buy in rather than making the decision for him.  Every treatment has implications and I personally feel this is one of those "my body/my decision" things.  Besides, you don't really want to be in a position where he blames you one way or another for the outcome, IMHO.

Beyond that, I have activated my email address that you can find on the left hand side of this reply.  If you want to email me directly I will be glad you give you my number or call you and discuss anything directly with you and/or hubby.  Just tell me you have done so on this thread as I don't check that particular email very often.

Tudpock

Well afterglo, looks like I am almost in the same age bracket as you folks, will turn 74 next December but feel like I'm only in the late 40's. After a lot LOT of research and reading so many many of the great posts here, I feel comfortable that I have also chosen to go the Brachytherapy route. I am set up for a second Volume Study up at the Chicago Prostate Center, Westmont, IL for May 24th and I have been advised that the Doc that will do my seed implanting has done well over 1,000 of these procedures with excellent results. If the old prostate has shrunk to a more acceptable/workable size, I'll have the seeds implanted on May 27th. I have been on a Bicalutamide pill daily since Feb 15th and got a Lupron shot exactly ten days later. No serious side effects yet other than a few very minor "hot flashes" which my local Uro Doc had indicated may happen. I was lucky and had the prostate biopsy done at our local hospital under anesthesia so it was truly a "piece of cake" for me. Was a little on the expensive side but was well worth it not having to feel or hear any of the procedure. Truthfully, my head is kinda spinning from the overload of information that I have assembled and digested on this PC stuff.
What makes me a little more on the apprehensive side is the fact that I am currently a 28 1/2 year survivor of cancer (clear cell sarcoma) Even after the 28 years of this stuff in my past, it still crosses my mind almost daily. I had surgery, radiation and chemo and to me, those three treatments were well worth the 28+ years of a good life. Luckily, I was accepted into a sarcoma study conducted by the National Institute of Health/National Cancer Institute at Bethesda, MD. All services were totally free of charge to me and after getting the current biopsy and prescriptions, I now realize just how much those free treatments saved me. Sorry for all the rambling on about this matter. I kinda get carried away talking about this stuff.
Good luck to you and Hubby and I'm sure everything will turn out just fine for you folks. Please do Keep us posted.

Afterglo, Like John T, I had BT (came home the same day) followed by 25 IGRT sessions. I had similar side effects from the seeds....urgency, frequency, some burning sensation. This may be all your husband encounters if he does the seeds only. In my case, I did experience some fatigue at the end ot the radiation treatments....and still feel a little lethargic a week after they ended. That said, I am very happy with my decision so far (although I have not had a follow-up PSA result yet). I made my decision for the same reason stateds by the other guys: Less invasive Fewer serious side effects that impact quality of life Comparable cure rates to surgery Radiologist who has done 700+ procedures I would expect that your husband would tolerate the seeds very well. Best wishes on your journey. Joe67

Afterglow,
A couple of answers to your questions.
Follow up external radiation after seeds is usually done for those with a G7 or above as the higher dose has a better chance of killing all the cancer. G6 cancers are usually ok with seeds alone.
Many radiologists suggest Lupron to shrink the prostate, Lupron has serious side affects. These can be avoided by taking Casodex and proscar for 3 months. The side affects are minimal and they will shrink the prostate up to 50%.
JohnT

Thanks for the heads-up on the Lupron, John T and for the names of alternative drugs .

Erbob, I hope that someone far more knowledgeable than I can provide answers for you.

Ht used to shrink the prostate should help urinary flow. My Flow increased significantly.
JT

Alf,

That's good advice. That is about what I was told when I was considering being "seeded" back in 2008. I was concened what it would mean being around my grandchildren if it had happened.