brachytherapy

Dear dmc 24:

I was a brachytherapy patient and have been pleased with the results.  I invite you to select the link in my signature if you would like to see some details about my "journey".

Also, without seeing the full stats on your hubby, it is really impossible to say whether or not he is a good candidate for the procedure.  Sometime back I posted the following and maybe this will be helpful:

A typical poster-boy candidate for brachytherapy will have Gleason 6 or less, a prostate size of 50cc or smaller, Stage T1-T2, and PSA less than 10.  With G-7, brachytherapy alone may also be used if all of the other criteria are met plus cancer found in only a few cores and with a small %.  Otherwise, the doc will typically use HT to lower the prostate size and/or supplement the brachytherapy with a 4-5 week course of additional radiation therapy.

I hope this is helpful.  Typically the cure rates from brachytherapy and/or IMRT are equal to surgery but with far less onerous side effects. 

As regal indicated, one of our forum members, JohnT, is a highly knowledgeable brachytherapy patient and he may weigh in on this thread as well.

Please let us know how you progress and feel free to email me if I can be of more detailed help.

Tudpock (Jim)

dmc24,

I had a combination of BT and IGRT. My first inclination was to have surgery but I changed my mind after doing some research....which included reading a lot of accounts here on the HW site. I finally decided that, at my age, remaining quality of life was very important to me and the treatment I finally chose has had very little impact on that so far....no ED and no incontinence. I'm very happy with my decision.

That said, you should explore all the options open to you and keep in mind that uros want to cut and radiologists want to zap. Get opinions from both and ,in the end, do what feels right for you. Other than that, I can't add much to what John T and Tudpock have said above.  Best wishes,

Joe

Dattoli is certainly an expert. On the other hand, many people wil find it impossible to go to Florida for several weeks or more, which is typically required if you are doing external beam radiation as part of your treatment (BT only would be substantially less time).

There are other radiologists with huge expertise, though for whatever reason their names tend to come up less often on these boards. Guys like Anthony D'Amico in Boston and Richard Stock in New York -- as just two examples. If you tell us where you are located, someone here can make a recommendation.

Of course, if you are in a position to travel to Florida and stay there for some weeks, Dattoli would probably be a great choice.

Most of the sources cited in the post by NY-Sooner are 10 years old.

 

It is undoubtedly true that many radiation oncologists downplay the incidences of ED when making their sales pitch just as surgeons frequently downplay both ED and incontinence.  And, it's true that ED with surgery generally starts out bad and may get better while ED generally starts out non-existent with brachy and may get worse.  However, most recent studies of brachytherapy vs. surgery show that ED at 2+ years is likely to be worse with surgery.

 

One interesting study is the one done by New England Journal of Medicine on satisfaction with quality of life.  There was a decline in sexual satisfaction scores for both surgery and brachy patients but the % decline was much less in brachy patients than in surgery patients. 

 

Some on this forum may argue the efficacy of surgery vs. radiation but few who have looked at the facts will argue about the ED issue.

 

Tudpock (Jim)

Regal,
Some of the surgery guys don't feel the same way you do about surgery which should not be surprising to you. I respect your decision on your therapy, and hopefully you can do the same about the guys who didn't go your rout. There is more than one way to treat prostate cancer and because it is a decision that we put our hearts into you can understand why the objection.

Personally it does not bother me as much because I am not afraid to fire back with knowledge that we still lack critical unbiased controlled trial corroboration on the efficacy and side effects of brachytherapy. That is finally getting underway but it will take a while to get accurate information on it, but I am happy to see that finally there is a serious controlled comparison between the two instead of rhetoric and brochures. For this particular poster the topic is about knowledge about seed therapy and not claims about surgery. Perhaps you can state your personal experience with brachytherapy instead?

Tony

As a surgery patient who is very satisfied with my treatment, and feel that my treatment was succeessful to a degree greater than what other treatments could offer me as a Gleaosn 9, I feel that someone who calls surgery butchery, is taking potshots, and I find it highly offensive.

I do not disparage any other forms of treatment, an in fact had not has such an aggressive form of PC, I would probalably have chosen other treatments.

People who come on this site with one liners, don't display their signature, and don't attempt to discuss the merits of the different treatment choices are in my opinion detracters form the great atmosphere of HW. We are here to learn, not attack.

Hey dmc,

There used to be a poster here named JustJulie whose husband was a brachy guy. You might search for her posts. She is very knowledgable about brachytherapy.

I know it's hard for some here to believe but there are alternatives to radical surgery and radiation. There's of course AS for those with low risk PCA. There's HIFU which likely soon will be approved by US insurance. There's cryo and there's clincial studies for which I am a poster boy for a success. Mine was Targeted Focal Therapy using cryo but now is also being done also with laser. Time does move on people.

Many here are still recommending the Walsh book published in 2007. While good it is becoming dated. The days of only radical surgery or radical radiation treatment choices are fading away. Although it may offend some here in another decade the former may well be looked on as butchery, and needless to some. There's no doubt for me that in time we will look back at this period as a period of much over treatment, caused by the advent of PSA.

Purgatory said...
careful there, realziggy, you used the "butchery" word. lol.

the walsh book, though dated, and anyone picking it up would have to know its obvious bias towards surgery, is still a good primer on most things basic about PC, before, during, and after. A good starting point for most people in my opinion.

of course there are all kinds of alternatives to surgery and RT, but those two treatments makes up the overwhelming choice in the end for most people.

david in sc

As I said in the other thread Dave I have a history here with banned posts. I still miss my Ziggy9 name.

We know there are alternatives to those two but some who come here in initially and look at posts much of the time would not see any, and just assume it's only the knife vs rads.

 Had Brachy this past December and never looked back. Having had four heart attacks in the last two years, another long hospital visit didn't intrigue me. After reading everything (including Walsh's book) I could get my hands on, the choice was clear. Everything went swimmingly. Catheter out after six days and never to be seen again. Still on flowmax but probably will be for some time.

Oh yea, the wife is very satisfied too!

Age 60, gleason 3+4 = 7, T1c, psa 4.2, 5 of 15 cores cancerous, prostate 26cc, Brachy Dec. 29th 2009, 76 iodine 125 seeds.

3 month psa  1.87

6 month psa  1.06

8 month psa   .77

thank you Dr Peter Carroll....

Dear toughasnails:

Glad your brachy went well.  I couldn't help but notice that your stats and mine are remarkably similar.  I just have a couple of post procedure questions where we were different:

1.  My catheter was out before I woke up and yours was in for 6 days...do you know why yours was in for so long?

2.  I was off of the Flomax after 3 months, never to return.  Do you know why your doc still has you taking it?  Have you tried going off it?

Tudpock (Jim)

my doctor gave me the option of going home with a catheter.  he said i had a 50% chance of having a problem.  i took his advice and the catheter was removed the next morning at his office.  i had brachytherapy a little more than three months ago and i am still on flomax 2x a day but i am also receiving IMRT. (eight treatments left).

F8