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Posted 2/4/2013 4:47 PM (GMT 0)
Hi!  A West Michigan Newbie here, seriously considering surgery.  But before I go under the knife (or multi-armed robotic thingy), I am seeking the input of PC brothers and their experience with Brachy.

Input to consider providing:

  • LDR or HDR?
  • How long since procedure?
  • Why'd you chose Brachy over surgery?
  • How are your outcomes compared to your expectations?
  • How'd you decide on your Brachy Dr.?
  • If you had to do it over-again, would you?
  • If you had it done any where near Michigan, where?
  • I fear seeds either might not cover all prostate tissue (kill the cancer) or damage more than prostate tissue.  Can you calm my fears?
  • Other questions I should be asking (and you could be answering)?

Thanks in advance for your input.

--Steve N.

Posted 2/4/2013 5:15 PM (GMT 0)
Steve,
i had combo Brachy/IMRT four years ago. Have no side effects of any sort and Psa has been a consistent 0.1. Brachy was chosen because I had both nerve involvement, tumor in the apex and transition zone all of which significantly increase the risk of surgical failure and ED and incontinence. I was more than satisfied with the procedure and compared to friends who had surgery at the same time my recovery was 10 times faster and ongoing SEs much better. I played golf the next day and all frequency and urgency SEs went away in 4 weeks.
With the new templets and imaging it is rare for brachy not to cover the entire prostate. All good doctors do a quality check within 2 weeks with a CT scan to verify the dispersion of seeds. The seeds focus radiation in a 1mm radius so damage to external organs is rare. Seeds can be added if dispersion is poor, but I have never heard of this being done. also in the rare event of failure you can be reseeded with a different isotope.
There are no guarantees in any treatments, but brachy gives the best chance at not having any side effects and it's 15 year track record is as good or better than surgery.
The Chicago Prostate center has an excellent reputation, but any brachy Dr that has done at least 500 procedures should be well qualified.
Posted 2/4/2013 5:24 PM (GMT 0)
Not a Brachy-brother but a Brachy-wife here - my husband is seven years post seeding.  To answer your questions, see below.  To follow our journey search "JustJulie's Brachytherapy Journey" for all the details ...

Input to consider providing:

How long since procedure?

  • SEVEN years out
  • Why'd you chose Brachy over surgery?
  • Less invasive, faster recovery time and surgery was riskier due to location of tumour - if they went too deep, incontinent at 44, if they went to shallow, cells could remain
  • How are your outcomes compared to your expectations?
  • Back to normal - no issues in any department
  • How'd you decide on your Brachy Dr.?
  • Recommended by Urologist
  • If you had to do it over-again, would you?
  • Yep
  • If you had it done any where near Michigan, where?
  • Princess Margaret Hospital, Toronto
  • I fear seeds either might not cover all prostate tissue (kill the cancer) or damage more than prostate tissue. Can you calm my fears?
  • We opted for standed seeding - seeds are stranded together to avoid migration and they are more controlled when being laid down - with 91 seeds, I don't think too much was left uncovered.
Posted 2/4/2013 6:25 PM (GMT 0)
"I fear seeds either might not cover all prostate tissue (kill the cancer) or damage more than prostate tissue. Can you calm my fears?"

My understanding is the seeds are planted close enough to get it all, as JohnT said (thanks for the additional info as well John).
Posted 2/4/2013 7:07 PM (GMT 0)
Dear Steve, welcome to HW. Sorry you have to be here but I think you will find it's a great spot for support and info. I will answer your specific questions but I also invite you to copy and past my "journey" at the end of my signature which will give you my long-winded insight into my situation.

Re your questions:

1. LDR or HDR. I had stranded LDR with iodine isoptope.
2. How long since procedure. 4+ years.
3. Why brachy: Cure is as good as surgery, considerably less invasive procedure, considerably less chance of bad side effects (urinary and sexual).
4. Outcomes vs. expectations: I had high expectations and they were met. Normal urinary functions and normal sexual functions, i.e. same as before procedure. Only lasting SE is reduced ejaculate by about 60%.
5. How did you decide on brachy doctor: References from trusted friends, checked on "best doctors list". While I am totally pleased, if I had known then what I do now I would probably have gone to Chicago Prostate Institute, Dattoli or Seattle.
6. Would I do it over: ABSOLUTELY, in a heartbeat, without a question.
7. Near Michigan: Chicago Prostate Institute...wait for Yooper's reply and you will see why.
8. Coverage: See JohnT's excellent answer; I can't add to that.
9. Other questions: Make sure your guys are very experienced, i.e. hundreds of procedures, ask for results of their work, talk with their patients.

Good luck, Steve, and keep us posted.

Jim
Posted 2/4/2013 7:07 PM (GMT 0)
I had HDR.   I also studied seeds.   I went with the HDR  for the better technology, advice of my medical oncologist, and I liked the HDR rad onc better.   I liked that the radiation would not be left in, no chance of seed migration, no problems with the normal changes in the body, and the two procedures gave the rad onc more dose accuracy and flexibility.    Both will do a great job and serve you well, but you have to seek out experience and expertise.  HDR can treat large prostates better than seeds due to the use of a different catheter template. 

I was too far advanced for surgery and thus chose brachytherapy, IMRT and HT.   I completed HDR and IMRT two years ago and have had no lasting side effects from the brachytherapy.   Immediate side effects were the normal urinary and bowel urgency and frequency and a little soreness when sitting for about two weeks.   I never missed any work nor did I need any pain medicine.   My PSA remains <.1 as of last week.

My rad onc was recommended by my urologist.   Together they had done over 1,000 HDR procedures at the time (4-6 per week). I also have a good friend that had HDR at age 70 with the added risk of dibetes, overweight, and a very large prostate.   He did very well and continues to do so.

I would do it over and have been an strong advocate brachytherapy, both seeds and HDR.

 For HDR look at Dr. Martinez in one of the Detroit subuarbs.   He is a nationally recognized expert.   I will try to get his location for you.  It is Dr. Alvaro Martinez, Beaumont Hospital, Royal Oak, MI.   Interesting new article at http://detroit.cbslocal.com/2010/12/16/beaumont-studies-single-dose-radiation-treatment-for-prostate-cancer/.  

For excellent research see www.cetmc.com, the website of the HDR pioneer Dr. Jeffret Demanes, who is now head of radiation therapy at the UCLA Medical Center.

Cancer control is as good or better than surgery.   The radiation destroys cancer where the surgery can not reach.   Radiation is used to salvage failed surgery.   Failed radiation most often means the cancer had already escaped the area (metastisized) and neither radiation nor surgery wouold have been successful. 

Posted 2/4/2013 7:12 PM (GMT 0)
I had HDR brachytherapy at UCLA and just completed my second and final session two weeks ago. I'm having it in conjunction with hormone therapy and IMRT.

I chose brachytherapy as the main treatment because:

1) its cure rate is comparable to surgery but most folks feel the side effects are somewhat less.
2) I was given a 50-50 chance that I would need salvage radiation after surgery, so instead of the prospect of having radiation AND surgery side effects I skipped ahead to the radiation side of the equation.
3) the combination of brachy, IMRT and HT appears to have the best rate of cure for Gleason 9s like me. (I realize this likely doesn't apply to you.)

It's way too soon to know if I chose right, but so far I'm comfortable in my choice. I have no worries about it killing all of the bad guys--the amount of work they do in HDR with the placement of the tubes and dosing leaves little doubt to me that an effective amount of radiation covered my prostate.

I did seem to have a slower recovery than others here that had HDR brachy. Some seemed to be back at work in a day or two...for me it was more like a week.

It's a personal choice and although I has started with surgery as my preference at the end of my weeks of research, this was the route that beckoned to me the most. You'll need to go through your own analysis and see what trade-offs feel right right for you. Good luck!

PS Where in Western Michigan are you? My brother lives in Holland and he had external radiation for his prostate cancer (but not brachy), and I presume he has some insights into various facilities in that part of the state.
Posted 2/4/2013 8:00 PM (GMT 0)

Hi Steve.  You asked for Brachy input - and as all the brothers and sisters out here probably expected - I would be happy to weigh in on this to help you on this part of your journey that involves information gathering towards a treatment decision.  Caveat - the following involve my own personal experience as well as information I gathered and by no means is meant to "tell you" what treatment to decide. . .  So then to your questions first:

  • LDR or HDR?     LDR Brachy / Monotherapy with iodine 125, stranded seeds
  • How long since procedure?     4-1/2 months
  • Why'd you chose Brachy over surgery?  After all of my research I clearly was able to conclude that Brachy has slightly better results than any of the other treatment modalities that fit my PCa profile, had significantly better SE's outputs (continency, ED, bowel) than surgery, and is far less invasive of an approach than surgery by far.  The statistics are there, I simply devoted the time and energy to cut through the chaff. 
  • How are your outcomes compared to your expectations?     On the one hand I had very high expectations based again upon the tremendous amount of research I did on LDR Brachy and also on the specific results of Dr. Brian Moran and the Chicago Prostate Center.  On the other hand I of course experienced the apprehension of being treated for cancer.  The outcomes exceeded my expectations.  Will I be able to say the same thing in 10, 15, 20 years?  Of course that cannot yet be answered, however based on the large number of gentleman that I have come to meet at the monthly sessions put on by Dr. Moran, including men that had this procedure 12 to 15 years ago - Yes, I believe I will.
  • How'd you decide on your Brachy Dr.?     I conducted multiple consultations, some in person, some by telephone.  I did my intensive research.  The clincher was meeting with Dr. Moran and his staff at the CPC.  Very rarely will one come across the combination of incredibly experienced and professional, yet compassionate and understanding.  The final key was during my initial consultation, when I asked Dr. Moran - "I see that you have done some 13,000 of these treatments, which speaks for itself - but my question to you is - 'what will make ME special, and not just one of 13,000 - as you must realize that at this point in my life there isn't a whole lot more important to me than this decision.'  While I did not write down his response verbatim, I will tell you that his answer simply blew me away.  To put additional emphasis on this, although he clearly didn't need to - he picked up the phone and called his chief of staff Joan McSweeney and asked her to join us, without telling her why.  When Joan came in Dr. Moran told her that I wanted to know how I would be treated as not one of 13,000 patients, but as someone very special; again, her reply while slightly different than that given by Dr. Moran simply astonished me.
  • If you had to do it over-again, would you?     Absolutely, 1,000% YES.
  • If you had it done any where near Michigan, where?     The Chicago Prostate Center in Westmont, IL.  With respect to travel, distance, I live only about 2 hours away - but that didn't matter.  After my treatment my wife, best friend and I went next door and enjoyed a fabulous seafood dinner before driving home.  Another patient that I talked to that had his Brachy done by Dr. Moran years ago shared with me that he stayed overnight at his daughter's in Naperville, IL and then the following day drove himself home to Colorado.
  • I fear seeds either might not cover all prostate tissue (kill the cancer) or damage more than prostate tissue. Can you calm my fears?     You didn't say specifically where your two positive cores were found, and I will also make the assumption that you have no perineural invasion, are probably a T1C, and NO / MO.  Based on that and more importantly the level of precision that the seeds are placed, and the small radiation field surrounding them - I was not worried about having the cancer killed nor doing damage to surrounding tissue / organs.  The full mapping study done on my prostate laid out the plan for seed placement, which includes targeting the cancerous cells/regions and at the same time sparing critical nearby organs including the bladder, urethra, nerve endings and bowel.  The post treatment CT scans showed the success of this plan.  I was given copies of both and also had Dr. Moran walk me through them.  I would also add that the seed implants are done "live" as well - with little to no opportunity for error in placement, regarding your two fears.
  • Other questions I should be asking (and you could be answering)?     If/when you consult with ANY of the medical practioners, ask them for THEIR specific results - % regression, SE's including continency, ED and bowel - and when you do have them explain for instance what does "continent" mean to them?  To you and I it means NO issues, while to others it may mean "only on pad per day", or "only when straining."

    • Steve, in closing I am impressed with your approach and due dilligence.  You are doing the right things; continue on and let me know if there is anything else I can do to help in your journey.  Feel free also to e-mail me if you wish, my e-mail address is in my profile.

    My very best to you.

    Posted 2/4/2013 8:19 PM (GMT 0)
  • LDR or HDR? -- LDR
  • How long since procedure? -- almost three years
  • Why'd you chose Brachy over surgery? -- 60% chance PC was out of capsule
  • How are your outcomes compared to your expectations? -- i'm in remission so expectations exceeded
  • How'd you decide on your Brachy Dr.? -- referral from uro
  • If you had to do it over-again, would you? -- yes
  • If you had it done any where near Michigan, where? --NA
  • I fear seeds either might not cover all prostate tissue (kill the cancer) or damage more than prostate tissue. Can you calm my fears? -- we combined IGRT and BT with seeds.  you may want to at least explore combination therapy

    • ed

    Posted 2/5/2013 2:00 AM (GMT 0)
    Good questions Steve.
    1. I had stand alone LDR Brachy. One treatment and done.
    2. Going on three years.
    3. In my 'second career', I work with lots of old farts like myself. Many have had prostate cancer. None with whom I spoke had the results that I wanted.
    4. My outcome is precisely what my oncologist said that it would be, and it exactly where I wanted to be. My PSA is 0.1, I am continent, and extremely active sexually.
    5. I did some searching on the internet and discovered that a highly experienced oncologist was only 70 miles away in Wheeling, WVA. ( Dr. Gregory Merrick-Schifler Cancer Center. Please Google Dr Merrick, and you will see why I was impressed. I also had a first hand account from a friend of a friend.)
    6. Steve, I would absolutely do it again, and I would encourage any PC patient who is 'eligible' to at least consider brachy.
    7. I would do it in Wheeling regardless of where i was in the U.S. or the world.
    8. No one can see the future, but again: 0.1, continence, active sex life. I couldn't imagine anything better.

    Good fortune to you, Brother, and let me add one more thing. I don't know if you would consider traveling to Wheeling, but when I had my consult with Dr. Merrick, I had a list of questions that were considerably longer than yours. I never asked one. After his presentation, my questions had all been answered. This facility also does both traditional and robotic prostate surgery, and we discussed these treatments as well. It was never really a close call for me.
    Posted 2/5/2013 10:28 AM (GMT 0)
    Hi Steve and welcome.

    Susan here, another ‘Brachy Wife’.

    Jeff had LDR Iodine 125 stranded seeds 2 years ago this Sunday.

    Surgery was never going to be an option as far as Jeff was concerned given the high risk of side effects and so our journey began – reading everything we could lay our hands on to find a treatment that Jeff felt comfortable with. The more we learned, the more drawn we both were to Brachy and were lucky enough to be able to have a consultation with one of the best in the field here in the UK.

    If we had to do it all again, yes absolutely, we’d do it in a heartbeat. When Jeff was diagnosed completely out of the blue we felt like our lives would never be the same again. Here we are 2 years post implant and life continues as normal. Outcome thus far has been exactly as expected and we are very happy to report zero side effects apart from the reduced ejaculate.

    You will make your own choice in your own time. Take your time as there are no 'do-overs' with this.

    Who knows at this stage if we made the right choice with Brachy, only time will tell, but I do know in my heart that we made the right choice for Jeff.

    All the best to you as you move through the difficult decision making process.

    Sending you a hug from over the pond

    Susan
    xx
    Posted 2/5/2013 7:27 PM (GMT 0)
    Steve,

    I started out assuming I was going to have surgery. After doing my research (including spending a lot of time on this site) I changed my mind and did a combo of BT and IGRT. Answers to your questions:

    * LDR (palladium seeds) followed by 25 IGRT treatments
    * 3+ years
    * Did not want surgery at my age. Cure rates were comparable to surgery. Became convnced that chances of onerous side effects were less than with surgery. After cure rate, QOL issues were very importand to me
    * My uro and my family doc
    * Absolutely
    * N/A
    * The combo of seeds and IGRT issue addresses this issue (and treats just outside the margins of the prostate)
    * Ask about the combo option stated above

    You are doing the right thing by learning all you can before you decide. As a result, you will make the right decision for you. Regards,

    Joe
    Posted 2/5/2013 10:30 PM (GMT 0)
    Steve,

    *LDR - 87 Palladium 103 seeds
    * 13 months post procedure
    * I just didn't like the side effects profile of surgery especially @ my young age, the curative rates for brachy met or exceeded in alot of cases the outcomes of surgery, as indicated by my research
    * Very good, and inline with others
    * Recommended by my urologist. After my RO consult, I felt comfortable with his experience level in brachytherapy, over 2000 implants.
    * Definitely, I was out of the hospital with a few hours of the procedure and recovery was a breeze. I couldn't gone back to work within a couple of days if I had wanted to
    * N/A
    * I asked my RO the same question. The seeding is done in such a manner to cover the margins in case they was PNI present. Also, volume study MRI, and post implant CT scan confirm the location of the seeds.
    Posted 3/10/2013 3:13 PM (GMT 0)
    "LDR or HDR?" - LDR 66 palladium-103 seeds, doctor told me HDR would have been "too aggressive" for my case of PCa

    "How long since procedure?" - 4 days post-procedure (March 6 2013)

    "Why'd you chose Brachy over surgery?" - cure rates equal to other modalities, QOL issues were a HUGE concern for me (continent to a surgeon might not mean continent to you or me is how several have described it to me), recovery time not comparable to surgery so that aspect of it was a no-brainer for me

    "How are your outcomes compared to your expectations?" - too early to give an answer really but no side effects so far and continent and erect, I expect to be cured (the center said I was cured right after the implant and I like that Gung-ho attitude so yeah, let's go with "buddy, you are cured")

    "How'd you decide on your Brachy Dr.?" - prayed to God, talked and talked to my loving wife, research, saw seven other doctors at local hospital, contacted UCLA when considering HDR, this forum's GREAT people (including advice from A Yooper aka "The Seedman"), other sources, consulted with family and friends, read books

    "If you had to do it over-again, would you?" - Yes! Yes!! Yes!!! This procedure is almost too good to be true honestly - PCa is *almost* like a bad dream

    "If you had it done any where near Michigan, where?" - Chicago Prostate Center (Dr. Moran has done 14,000+ of these)
    Posted 3/10/2013 7:37 PM (GMT 0)

    JustJulie said...
    Not a Brachy-brother but a Brachy-wife here - my husband is seven years post seeding. To answer your questions, see below. To follow our journey search "JustJulie's Brachytherapy Journey" for all the details ...
    Input to consider providing:

    How long since procedure?

    • SEVEN years out
    • Why'd you chose Brachy over surgery?
    • Less invasive, faster recovery time and surgery was riskier due to location of tumour - if they went too deep, incontinent at 44, if they went to shallow, cells could remain
    • How are your outcomes compared to your expectations?
    • Back to normal - no issues in any department
    • How'd you decide on your Brachy Dr.?
    • Recommended by Urologist
    • If you had to do it over-again, would you?
    • Yep
    • If you had it done any where near Michigan, where?
    • Princess Margaret Hospital, Toronto
    • I fear seeds either might not cover all prostate tissue (kill the cancer) or damage more than prostate tissue. Can you calm my fears?
    • We opted for standed seeding - seeds are stranded together to avoid migration and they are more controlled when being laid down - with 91 seeds, I don't think too much was left uncovered.

    Hey Julie......did your husband do any HT with his BT....I had mine done in Moncton.
    Posted 3/11/2013 1:05 AM (GMT 0)
    I am seriously considering Brachytherapy, as well. Anyone have any experience with Dr. W. Robert Lee at Duke Cancer Center for Brachy? Or, Dr. Ronald Davis at Wake Forest Baptist? Knave appointments with both of them next week.

    Robert
    NC
    Posted 3/11/2013 3:40 AM (GMT 0)
    One of the problems I struggle with as a moderator is the temptation to copy edit. Robert tried to say "I have appointments" but he was body checked by his spell checker and his shot went wide.
    Posted 3/11/2013 12:58 PM (GMT 0)
    Thanks, Peter. My eyes are getting dim too in my later years... cool

    Robert
    Posted 3/11/2013 3:38 PM (GMT 0)
    You can read my story by clicking on the link in my signature.  It should answer all of your questions.

    Good luck to you.  Take your time. 

    Posted 3/11/2013 6:51 PM (GMT 0)
    FoxRun:

    The only procedure done was the stranded seed Brachytherapy - nothing else and he's doing great!

     

    Posted 3/11/2013 7:31 PM (GMT 0)

    JustJulie said...
    FoxRun:
    The only procedure done was the stranded seed Brachytherapy - nothing else and he's doing great!

    NO HT, good for him(and you).....lol..... what kind of PSA bounce did he have? I noticed Surgery in his BIO?
    Posted 3/11/2013 7:35 PM (GMT 0)
    FoxRun:

    The surgery referred to was his Brachytherapy implant as he was completely knocked out so I deem that to be surgery.  His bounce was almost double his previous reading (but below his initial diagnosis) which is apparently totally normal and expected (to the doctors maybe but I wasn't expecting it)!

    Posted 3/11/2013 9:26 PM (GMT 0)
    I had brachy 2 1/2 weeks ago and I would recommend it as mild and tolerable side effects.

    Ultimately, its will be a decison that you have to make. I stayed away from surgery due to concerns about long-term major side-effects, particularly incontinence and ED, and an admittedly personal and probably unfounded fear that some cancer cells might not be removed. (It was mainly the side effects.) I was also not thrilled about a catheter, even for a few days.

    So I did 15 months of active surveillance after diagnosis. I didn't think I'd avoid treatment, I just wanted to the the science advance as far as possible so maybe I could take advantage of new and better treatments. PSA's were very good (below 4) but then two consecutive above 5 and 2nd bisposy showed slow spread of low density Gleason 6. No sense waiting and I had decided brachy was going to be the treatment for me.

    I was home the evening of the procedure and after 2 doses of pain meds, I didn't need them any more. I resumed unrinary function before I left the hospital. It hurt, but my suggestion is that you pee as soon as you are able, because it gets easier the more you go and the sooner you start to flow, the less the chance of a blockage. (Not to be too graphic, but my first pee after the procedure produced a small clump of bloody goo that I have to think was good to eliminate it before it had a chance to set and become and obstruction. Drink lots of water, too.

    I have had the sense of blockage in bowel and urinary functions. Things take longer, but not really a problem. I take a stool softener just to make things easier and I have not needed Flomax, though most guys do.

    As for irradiation of surrounding organs - it happens, that's why you have urinary and bowel irritation, but my belief was that external beam radiation has to go through all those organs to get to the prostate and then penetrate all the way through it. I liked the idea of focusing the radiation within the prostate and it made sense to me that surrounding tissue would get irradiated, but to a lesser degree than external radiation. I was told secondary cancers are not a concern with either treatment.

    As to how I chose my radiation oncologist: I trusted my Uro who has been working with him for many years. I liked him when I met him and I really have a high opinion of the hospital where they perform the procedure. I did not shop around. It all felt right and I went with the flow. I feel very good about it.

    Good luck. It's your call and you have the good fortune of several really efefctive options, with more on the way. Do your homework and make the decisions that you feel are right for you.

    And it's OK to pray.....

    Good luck!

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