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Posted 7/26/2012 4:10 AM (GMT 0)
So as I go down the path of trying to determine the "best" option to treat my PC, I am now researching HDR Brachytherapy.  I would appreciate any input as to anyone that has either gone this route, or decided not to. 

My stats are as follows:

55 years old, 5'11" 190#'s and in excellent condition, until the PC diagnosis of course....

PSA increased from 3.8 to 5.8 over the course of 3 years.

Biopsy on 6/27/12.

Results = Gleason 7 based on 3+3, 3+3, 3=3, 3+3, 3+4, 3=4, 3+4.  22 grams, TC1 (2nd opinion has confirmed all of this)

I am scared S#&*less of having a prostatetcomy, and am trying to learn more about HDR Brachytherapy.  Anyone that has any experience, opinions, etc I would love to hear from you. . . .

Posted 7/26/2012 5:30 AM (GMT 0)
I did consider seeds but chose IGRT instead for a couple of reasons:

There was some concern about cancer being in the margins for me. My RO felt he'd have a better shot at getting to all the areas the biopsy showed with a beam.
Seeds would have required general anesthesia in my case and my docs like to avoid that in me (heart/lung issues).
With my insurance plan I would have had to travel about 4 hours to another city to get the treatment but the IGRT was done a clinic 15 minute drive from my house. Plus all my other docs, Uro, primary are with that clinic.
The RO I really liked only did beam work and would have had to refer me to another RO for the seeds.

However I still came very close to doing the seeds and if the IGRT fails I still might do the seeds. I really went with my RO's recommendation that he thought starting with IGRT would be best for me. If I do have seeds my RO said he knows a anesthesiologist that could get me safely under even with some of my other problems (looks like I'll get to try him out with my up coming hernia surgery).

I know how you feel about the RP and think you'd do just fine with Brachytherapy. Keep checking it out.

Let us know what you decide.
Andrew
Posted 7/26/2012 11:13 AM (GMT 0)
When I was diagnosed in 08, the biopsy came back with one of 12 samples at a GL6. I chose AS although it was called watchful waiting at that time. Someone decided that calling it watchful waiting suggested that you were doing nothing...thus the change in the name. I was quite comfortable with that, and did it for 18 months, but my psa went from 4.3 to 6.1.
I was pretty concerned at that point, and had done considerable research. Surgery scared the heck out of me, but when you meet with surgeons, surgery is the only answer. That attitude really turned me off. I had an actual discussion with Dr. Walsh, and I came away with a very different opinion than most on here have.
My path finally led to the Schiffler Cancer Center in Wheeling WV where I was thoroughly schooled in ALL possible treatments. After a mapping biopsy which showed 15 GL6's and one GL7 out of 60 samples, I was told that I now had a 'significant cancer' but in my case, there were numerous options...all of which would give me an excellent chance of long -term survival.
Call me foolish, but my major concern was and remains the potential side effects, many of which I had seen in my friends and acquaintances. My main fear, frankly, was ED. I was told that while ED is still a possibility with brachy, these patients generally respond more readily to oral medications.
After leaving Schiffler, I felt that finally I had received an objective and comprehensive evaluation of my situation. I chose brachy, and have never looked back.
As I said before, this was my experience. I would never try to sway anyone's decision, but I am very happy with mine. By the way, Dr. Gregory Merrick was/is my oncologist. I would recommend him to anyone, and encourage you research his career for yourself.
God Bless
Posted 7/26/2012 12:52 PM (GMT 0)
I just completed my 12 months of combo treatment. Anything specific you want me to comment on?  
Posted 7/26/2012 1:09 PM (GMT 0)
I am gonna guess you are asking about High Dose Brachy., which is the one time procedure done under aneastesia (never could spell that word) , in a hospital, over a 24 to 36 hr. period, with the seedings left in place during that period and removed at the end, as opposed to the regular seeding which uses smaller dose, is left in the prostate and slowly radiates to a point where they no longer have any radiological effect? If so, then that's a different situation than that of the normal brady procedure. There's a couple guys here who have had the High Dose treatment, maybe they will see you question and respond.

I think the tradeoff would be a hospitalization overnight, with the seed implantation device left inserted thru the rectum during this period, but all traces of the procedure removed when finished, with a targeted one time high dose radiating of the area. Uncomfortable for the duration, but doable, considering the possible benefits of the one dose and done, higher radiation and extended margins coverage gained. My doc. said that they could use the stronger dose to radiate out past any cancerous margins, which would cover the same areas as beam radiation could (to an extent) , whereas the regular left in place seeding had to be lower dose and didn't extend beyond the margins adequately. Hope this clarifies the situation for you.
Posted 7/26/2012 1:28 PM (GMT 0)

http://www3.islandtelecom.com/gkavanagh/MyBrachyProcedure.pdf

Posted 7/26/2012 2:20 PM (GMT 0)
JNF is the "authority" for HD Brachytherapy on this board. Hopefully he will join in soon and contribute to this discussion.

I considered Brachytherapy before ultimately going the proton route. For various reasons all of my docs advised against Brachytherapy as the best treatment for me. However, for many it seems to be an excellent solution.

In doing my research I did find that I leaned greatly toward going the HD Brachytherapy option as the relatively short-term high dose and then removal of the "seeds" appealed to me. UCLA seems to be the epicenter of HD Brachytherapy, although many hospitals/clinics offer it around the country.

Good luck on whichever way you decide to go.
Posted 7/26/2012 2:50 PM (GMT 0)
Hi Yooper,

Sorry you have found the need to join us but welcome all the same.

“trying to determine the "best" option to treat my PC” – oh boy if only it were that easy.

When my husband Jeff was diagnosed following a routine health check it was like the rug had been pulled from under us. He too was fit and healthy; he had no symptoms so we really didn’t see it coming. Jeff ruled surgery out immediately based on the high probability of side effects, which for him was a no-no and so our journey began, reading everything we could lay our hands on.

Jeff didn’t have HDR, he had permanent seed Brachytherapy 17 months ago but there are others who have had HDR who will hopefully chime in soon. Insofar as side effects, to date he has none and we are very pleased with his treatment choice.

Just wanted to wish you all the best with whichever treatment you decide on.
Posted 7/26/2012 2:56 PM (GMT 0)
A Yooper,

I had HDR brachytherapy and am a proponent of it based on my research and actual experience. My urologist-surgeon said I was too high risk for surgery (my med-onc agreed) and both recommended HDR brachytherapy with adjuvant IMRT and ADT3 hormone therapy. I consulted two HDR practices in Atlanta and did web research based on the work of the HDR pioneer Dr Jeffrey Demanes. He now heads the radiation department at UCLA Medical Center. His website is www.cetmc.com. I also researched Dr Martinez in Detroit as my rad-onc follows some of their protocals.

I also considered permanent seeds as we have one of the best seed clinics in the world here in Atlanta headed by Dr Frank Critz. He pioneered the use of permanent seed brachytherapy and adjuvant external beam radiation. I also used information from the Seattle Prostate Clinic, Dr Peter Grimm, and Dr Michael Datolli; all premier seed operations.

In the end, my decision was based on the fact that HDR use better technology to deliver a more exact dose to each treatment area than seeds and, since the radiation is not left in the body, the problems with seed dose migration due to the normal body changes would not occur. I believe that the HDR can deliver better curing doses with less damage to healthy areas due to the technology. My med-onc, also a proponent, said that "seeds are last century, HDR is 21st century".

Having said all that, I would have chosen seeds over HDR if I suspected the seed practioner to be better than the HDR practioner. Both processes have proven to be as effective or more so than surgery and with fewer side effects. But at the end of the day, the doctor performing the procedure is the most important factor in my mind.

For excellent information visit the following websites: for HDR see www.cetmc.com, and for seeds see www.prostrcision.com.

Best wishes and let me know how I can help,

Jack
Posted 7/26/2012 3:06 PM (GMT 0)
Thanks again to everyone out here - I am on that part of the journey where I am garnering as much information as I can to the point of near-overload, but know this is an important part of this process.

JNF - could I ask where you had your HDR done? Also how things went post procedure? Your comment about going with the best practioner is something I also believe, and to that end I have made the statement on another post on the HW forum site that $$ will NOT be a factor in my treatment decision, so if possible my goal (once I have decided on a treatment) would be to have treatment done by the best. CET/UCLA seems to come to the top with respect to HDR Brachy, and as I live in SE Wisconsin that will bring additional challenges so the more I can learn/understand about this process the better.

Thanks much. . . .
Posted 7/26/2012 3:10 PM (GMT 0)
I finished Proton Therapy about 6 month ago. So far all is well. See my signature. Please do yourself a favor and at least check it out. I am pleased and have had minimal SE. I am originally a YOOPER. I've been in Florida a long time. Good luck. Wishing you the best whatever treatment you decide on. You can also email if you like.

Posted 7/26/2012 5:57 PM (GMT 0)
Yooper,

I went to the Georgia Center for Total Cancer Control in Alpharetta, Georgia, a northern suburb of Atlanta. They are part of Atlanta Oncology Associates. I also looked at the St Josephs Hospital Prostate Cancer Center as I have a friend that had HDR there a year before. Also my med-onc is on their Prostate cancer staff. My doctor has done more than 1,000 HDR procedures and performs 4-6 per week. His older partner has been performing HDR brachytherapy since the mid 90's, so a lot of HDR and prostate specific experience.

I have done wonderfully well and have no side effects or problems from the HDR or the IMRT that was also administered. My side effects are from the ongoing ADT3 hormone treatments that I will have for another 15 months.

In my case I had two HDR procedures one week apart. I was not hospitalized at any time. I would show up at the hospital at 10:30 am and be prepped for the prodcedure. At noon I would receive a spinal block and light sedative so I was numb and asleep as the 15 catheters were inserted, which took about 45 minutes. I woke up and was transported from the hospital to the radiation treatment center by ambulance. At the center a series of ct scans aided the final adjustments to the catheters. The doc, physician, and dosemitrist then finalized the radiation dose plan. Each catheter was hooked to a long tube which was hooked to the radiation afterloader and the radiation process began by running an irridium tipped wire into each catheter. The dose program determined how long the irridium was in each position to deliver the amount of radiation needed. This process took about 20 minutes. I was then observed for about an hour and the urinary catheters and urinary catheter were removed and I was free to go home, though I wasn't allowed to drive due to the anaesthesia. By now it was about 4:00 pm.

Some HDR practioners will perform 2 or 3 procedures over a 24-36 hour time period which keeps you in the hospital overnight An advantage is that you are only anaesthetized once, but I understand it isn't fun having the catheters in that long as you are completely imobile while they are in.


I had no restrictions and worked the next day. The first procedure left me with some urinary discomfort for a couple of days. This was corrected the second time as the urologist used a stronger numbing cream before inserting the urinary cathter. With each procedure it was tender sitting for a couple of days and I avoided hard chairs for a couple of weeks. My lower groin, penis, and scrotum turned black as there is some internal bleeding that settles in these areas. This is the same for permanent seeds. A little wierd for a week then it turns yellow and green for a few days.

I am completely continent and the only sexual function limitation has been introduced by being 21 months without testosterone. More a lack of desire than an inability to function and will reverse once the Lupron injections stop The IMRT side effects were limited to increased urgency and frequency of both bladder and bowel function. This cleared after a few weeks once the radiation stopped. I never had any radiation burn nor was I fatigued.

Overall, and very fortunately, the HDR and IMRT was a piece of cake. Some men have more pronounced side effects, but I did not. Nor did my friend who was 70 and significantly overweight and diabetic when he underwent HDR in 2009. My positive experience is why I would strongly encourage all men to thorooughly concider HDR. As for your location in Wisconsin, traveling to Demanes at UCLA or Hsu (another well known practioner in California may be a difficult option. You could get to Dr Martinez in Detroit. If you want to come to Atlanta, in the spirit of GFMPH you are welcome to stay at my house and I will even transport for the treatment.

Best wishes in your search and let me know how I can help.

Jack
Posted 7/26/2012 7:37 PM (GMT 0)
Hey Everyone!

I guess I'm the "oldtimer" when it comes to singing the praises of Brachytherapy but I'll keep on going.

My husband had Brachytherapy six (yes six) years ago with very little side effects and great results.  Just back from his "clear for a year" checkup and all is good.

I'm up to answer any brachytherapy questions you might need answered (or, in fact, if you're married I can answer any your wife might have too as I'm the wife of a brachy patient) so fire away!

Posted 7/27/2012 3:04 AM (GMT 0)
Thanks Jack and Julie for your posts, I really can't believe how many people stay on here to help those of us that really, really need it. . . .

Jack, thanks so much for the detailed post from someone that has gone through an approach that I am considering. That level of detail really helps me understand not only what to expect if I choose HDR Brachy, but also to at least understand what your post op situation was/is. And, incredible that you would offer a place to stay and transportation, not much I can say about that incredible reach out. . . . I will put it in my bag of information towards making a decision for sure - thank you.

I've got an appointment with the radiation oncologist at Froedtert in Milwaukee this coming Wednesday, and will add that to my bag of information.

FoxRun, if you could reply with details similar to JNF's above I would really appreciate hearing how it all went for you.

I'm also going to look into the Proton approach as anxious in florida has suggested, trying to keep all of my options open towards this MONSTER decision making process.

Thanks all. . . . .
Posted 7/27/2012 11:04 AM (GMT 0)
Hi Yooper,

This has been a great thread for you and look at how much more you now know in the short few days as a member of this forum.

If you would like to have a chance to meet 30 to 40 of the members in this forum in person, I would encourage you to attend a gathering we call GFMPH Yankee Style the last week end in September in the Rochester NY area. If you want more information on this please send me an email and I will send you my phone number. By the way GFMPH means Good For Mens Prostate Health.

Terry The Water Guy

Posted 7/27/2012 12:14 PM (GMT 0)
Hi Terry,

Yes, these threads have been an incredible resource for me - I can't say thanks enough to everyone out here that has posted.

Thanks also for giving me an invite to the gathering, I will keep that in mind. Not sure where I'm at yet with my decision for type of treatment, nor where/when I will have this done so that will also come into play.

Anyway thanks everyone and please keep them coming! I am combining what I hear on this site from those that have gone through this process and various options for treatment, along with more internet research and talking to health care professionals as well. Hopefully all of this will put me in a position to make the best possible decision.
Posted 7/27/2012 12:23 PM (GMT 0)
If you're looking for a detailed report, you can follow our journey if you search "JustJulie's Brachytherapy Journey" you'll find ours - it will give you an insight from start to finish including all the emotional triggers you might not consider ...

Best of luck in your decision - my only advice on that front is choose an option and don't look back ....

 

Posted 7/27/2012 2:13 PM (GMT 0)
Wow Yoop

What a great thread.

You are getting a wealth of information. This thread exemplifies the best of HW!

Mel

Posted 7/27/2012 2:46 PM (GMT 0)

A Yooper said...
Thanks Jack and Julie for your posts, I really can't believe how many people stay on here to help those of us that really, really need it. . . .

Jack, thanks so much for the detailed post from someone that has gone through an approach that I am considering. That level of detail really helps me understand not only what to expect if I choose HDR Brachy, but also to at least understand what your post op situation was/is. And, incredible that you would offer a place to stay and transportation, not much I can say about that incredible reach out. . . . I will put it in my bag of information towards making a decision for sure - thank you.

I've got an appointment with the radiation oncologist at Froedtert in Milwaukee this coming Wednesday, and will add that to my bag of information.

FoxRun, if you could reply with details similar to JNF's above I would really appreciate hearing how it all went for you.

I'm also going to look into the Proton approach as anxious in florida has suggested, trying to keep all of my options open towards this MONSTER decision making process.

Thanks all. . . . .

Hey Yooper,

 I doubt if I could come up with as good a detail as JNF, but i will try.

I did keep a diary of my more eventful days and I may have to review it to provide some specific details., but meanwhile I'll give you a summarized version(while I'm here at work). My whole experience with PC, the treatments and the SEs has been nothing short of big lesson in life. From the first time the C word was mentioned up until today, my adventure was alreay mapped out for me. I was very fortunate to have been on the good side of that adventure so far(knock on wood). My options, much like my knowledge, was very limited and I did not have the luxury of time to think it over. My 2 HDR RT treatments  spread out over 2 months, my 5 week external radiations and my HT for 12 months all went well. My only challenge was the HT with the Flashes and the the insomia and of course the lack of libido.

 

Posted 7/27/2012 7:16 PM (GMT 0)
FoxRun, thanks for the post - I too work a "normal" day and try not to spend all day on line, but it's pretty hard not to this early into learning I have PCa. When/if you have time I would like as much detail as you're willing to share; feel free to e-mail me if you're more comfortable with that as opposed to posting.
Things like where you had your treatment done and by whom, and how the procedures were done and your side-effects. Sorry for the "50-questions approach" but as I'm sure all of you out here know that's part of the process and most likely my current stage in all of this!!!!

Julie, I wasn't able to find your journey, can you post or e-mail the link?

Thanks all. . . .
Posted 7/27/2012 7:20 PM (GMT 0)
Hope this works - here's the link!

https://www.healingwell.com/community/default.aspx?f=35&m=710102

 

Posted 7/27/2012 7:40 PM (GMT 0)
Hi again Julie, found it! Just, beautifully, heartfelt, wow. . . I can't believe all of the insight I'm getting out here as I continue on my journey towards making my decision. Have felt/am feeling all that you so eloquently described - thank you for taking the time and effort to record all. Any of you guys (and gals) out here who haven't read this yet, really should.

I noticed the last of the journal ended back in 2007 - how are things today? Also, during the period after treatment (first year?) what kind of side effects did your husband go through?

Julie, thanks again - all of you out here are starting to join my guardian angels club. . . . .
Posted 7/27/2012 7:49 PM (GMT 0)
I've decided it's time for an update so check for a new post.  I can, however tell you this ...

He made the decision for Brachytherapy and never looked back.  PSA came down at first visit and continued to drop until the dreaded 18-month "bounce" that gives everyone heart attack (but is perfectly normal).  Then is slid again and again and every year that he hears "your PSA is 0." he's happy -he doesn't care of the number behind the zero, just the zero.

First year after treatment, no problems, back to work full-time in heavy construction, fatigue was controllable and no "disfunction" - to this I can attest so all in all - back to "normal".

Posted 7/27/2012 7:52 PM (GMT 0)
Yoop, Julie was one of the pioneers on HW who posted from a brachy perspective...she was quite influential in helping me with my brachy decision and I'm thankful for it.  I'm glad to see her stop in from time to time.

I think HDR brachy is a fine choice for your stats but the RO will help you will that perspective.  I did LDR brachy and if you are interested in my journey feel free to copy and paste the address at the end of my signature.

Glad you are getting the help you need.  It's a bit like drinking from a fire hose but you will find it's MUCH better to get yourself educated so you won't feel the urge to look back and second guess later.

Jim

Posted 7/27/2012 9:16 PM (GMT 0)
Hi Jim - yes I agree that Julie has been one of you that has had immeasurable impact on my journey - I see she started a new thread so I'll be all over that one as well!

Thanks also for sharing your journal - another incredibly detailed / helpful / well-written narrative. I saved and printed both and will hopeful use both as impeccable examples of how to do my own so that I too may at some point be able to "Pay Forward" out here.

At my age (55) I'm still more than fully employed so I'm not able to devote 24/7 to this journey, but will amp that up over the weekend.

Thanks again to everyone out here as well - I'll be around. . . .
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