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has brachytherapy seed implant improved 2012

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Posted 1/11/2013 7:44 PM (GMT 0)
I was wondering if anyone knows of any advances, I see the tethered seeds now! and much less migration. also a very high dose seed. what is the gleason score and t2c score that Brachy is acceptable? where are the reknown Brachy centers? would 3 patients a year be too low a count?
Posted 1/11/2013 8:02 PM (GMT 0)
Guess I'll weigh in on this - see my answers below:

I was wondering if anyone knows of any advances, I see the tethered seeds now!  They are considered "stranded seeds" and is pretty much the standard with LDR Brachy now.

and much less migration. Yes, very little chance, almost none, for migration with the stranded seeds.

also a very high dose seed.   My activity per seed in mCi was 0.382 and is "higher" than what may have been the standard in years past.

what is the gleason score and t2c score that Brachy is acceptable? Prostate Brachytherapy as a monotherapy is typically described for T1c to T2a, G2-6 (7 if 3+4) and PSA <10.  These are general guidelines only.

would 3 patients a year be too low a count? YES!  Way too few!  Mine had done over 13,000 over 15 years - but also keep in mind it's not only quantity - but QUALITY that counts as well.  Someone once told me that I may golf 18 holes a day, 5 days a week - but that doesn't make me a good golfer!

where are the reknown Brachy centers?  I would highly recommend that if you want to know more about state of the are LDR Brachytherapy that you contact The Chicago Prostate Center at 630-654-2515, website at http://www.prostateimplant.com/ You will find them incredibly helpful and "user friendly."

 

There are others as well, such as Dattoli in Sarasota Florida, and The Prostate Cancer Treatment Center in Seattle - these are all state of the art, up to current technology facilities - and I would offer some of the "Best" in LDR Brachytherapy today.  (Your post was 'brachy seed implant" which I took to mean LDR, there are also some fantastic HDR facilities/practioners out there)

 

Hope this helps - and keep on asking!!!!!!!!!!!!

Posted 1/11/2013 8:05 PM (GMT 0)
Hi Berdoo Man:

I saw your response on the other thread but thought an answer on this one might be best so folks can focus on YOUR issues.  Re your questions:

1.  Tethered - or stranded as the RO's tend to call them - seeds are more standard now.  This prevents the occasional migration that used to happen with unstranded seeds.  But, honestly, even if your RO does unstranded the chances of migration are small.

2.  For "low dose brachytherapy" there are two main type of isotopes used, iodine and palladium.  Palladium seeds produce radiation more rapidly and have a shorter half-life.  The urinary SE's for palladium tend to onset a little quicker, may be a tad more severe but dissipate more quickly than iodine.  Some researchers feel that palladium is better suited for faster growing, more aggressive tumors where iodine may be used for slower growing tumors.  I think the truth is that RO's typically pick their favorite and I would not make your decision based on the isotope used; the expertise of the doc is much more important.

3.  There is also "high dose brachytherapy" (HDR) in use today and I'll let JNF or one of the other recipients of that treatment chime in.

4.  For LDR brachytherapy to be used as monotherapy, it is generally suggested that the Gleason be 6 or a 7 with a low PSA (under 10) and a small number of samples and relatively low percentages in each sample.  Otherwise LDR may be suggested with IMRT added.  I'm don't think this is strictly true for HDR but, again, I will ask that the HDR boys comment on that.

5.  Yeah, 3 patients a year is definitely too low.  Run away from anyone with that record.  I would suggest having a doc who had done well into the hundreds, i.e. 300+.

6.  For LDR centers of excellence, I would suggest three:  Seattle Prostate Institute,  Chicago Prostate Center and Dattoli in Sarasota.  I am sure there are more but those three are top of mind with me.  I think our friend Yoop recently had his brachy done at the Chicago Center and he was pleased to say the least.  I personally know folks who have gone to Datoli with great results.  Again, I will let the HDR guys comment on HDR centers.

Hope this helps and good luck,

Jim

Posted 1/11/2013 8:15 PM (GMT 0)
thanks guys, Chicago here I come? if I qualify psa now 10.4 maybe they can lower it to get under 10? But I guess the T thing is significant. My biopsy is wednesday 12 + up to 16, he said he target interesting areas. also I am getting a general lullaby, so I am not bothered much, NOT Looking forward to the fleet job!!! I have never ever administered one??? I guess I am joining a club?? sorry to be here but you guys are great with the gospel. All I get on the web is propaganda, advertising, etc. also the Gleason 3 + 4 is critical to stay at 7 or below?
Posted 1/11/2013 9:55 PM (GMT 0)
would 3 patients a year be too low a count?

 

my doctor did three the day he did mine.

ed

Posted 1/12/2013 11:42 PM (GMT 0)
Berdoo Man - if you decide on coming to Chicago let me know, I can help with details etc.
Posted 1/13/2013 12:02 AM (GMT 0)
2. For "low dose brachytherapy" there are two main type of isotopes used, iodine and palladium. 

my doctor uses cesium.

ed

Posted 1/13/2013 12:43 AM (GMT 0)

Berdoo Man,

Most of my research has been focused on Brachytherapy High Dose Rate (HDR) so I will only comments on that.  I think a lot of the improvements that have occurred in the past few years in the HDR world have been with reducing the number of fractions and shortening the time between the treatments sessions where one or more fractions are given.  For instance my cancer center is giving me two fractions separated by one week.  When I started doing my research I was hearing mostly 3 fractions separated by a week.  In research since I settled on HDR I have even read where some centers are doing one fraction and getting similar results.  But as with all success stories it takes years to say “this is successful”.  I don’t take too much stock in 5 year survival rates.  I was diagnosed in 1999 and had a rum and coke every night for the next five years and my cancer hadn’t progressed one bit.  So was rum and coke the cure all?  However at 12+ years I am looking to have HDR.  Joking aside I would look for treatments that have survival rates in years that make you (and I emphasize you) comfortable.  Even given two men the same age, I may be happy with a 10 years survival rate – the next guy may not be.  The same goes for side effects – what I can live with is probably totally different from what the next guy can deal with.  I probably haven’t told you much except you have to do what you are comfortable with.

 

Best of luck in any decision you make!

 

David

Posted 1/13/2013 1:28 AM (GMT 0)
I used HDR brachytherapy for several reasons. My urologist and oncologist suggested it and my research confirmed that it is a more advanced method of brachytherapy. I was clearly too advanced for surgery.

For permanent seeds add the Radiation Center of Georgia (part of Northside Hospital a NCI cancer center) to the list. Prostrcision is the method that uses adjuvant IMRT and permanent seeds pioneered by Dr Frank Critz.

At the end of the day, permanent seeds or HDR will both do the job, just like open surgery and robotic. The real key is to use the very best doctor and clinic you can find. My rad onc/urologist do six per week and had done more than 1,000 together when I did HDR two years ago. My uro is early 40's and my rad onc is late 30's, and this is their specialty. The permanent seed operation in Atlanta I mentioned had done nearly 20,000 procedures (four doctors) when I consulted with them. You must find someone that specialized in the procedure and the number of procedures is one indicator that must be used.

My med onc suggested HDR saying that "seeds are last century...HDR is 21st century". I liken the difference to open surgery versus robotic....all things being equal, there are advantages to robotic due to the technology. But again, tghe doctor and staff is the most important factor.
Posted 1/13/2013 2:02 PM (GMT 0)
thanks guys, I am still reeling over the negative results reported on all treatments.that 10 year survival in all treatments is basically the same. It seems there may be an errors in reporting? I have NEVER known a man to die of prostate cancer. I know 2 now. one was diagnosed at 60 and was 85. It had
progressed into his bladder and he was in quite a bit of pain, but under control with drugs, Narcotics, and constipation treatments. Bottom line is I am unable to sit here and do nuthen. But I am currently focusing on the least invasive, and the fewest side effects. berdoo Rodger, but no longer live in Berdoo.
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