HealingWell
Search Close Search
☰

Question for Men Treated with Brachy

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 3/20/2013 11:09 PM (GMT 0)

Can seeds be deposited in seminal vesicles if you have SVI?

Was told by my RO they could not be.  But just read where a big

treatment place in Georgia says they can be. 

Has anyone with SVI had seeds as a mono treatment?  Or would it

require a combo treatment with IGRT and Hormones?

Phil

Posted 3/21/2013 5:20 AM (GMT 0)
Phil,

I watched a video of Dr. Gregory Merrick at the Schiffler Cancer Center (Wheeling, WV) implanting seeds and he placed one seed in each seminal vesicle. If I remember what he was saying (talking while he was doing this to the video maker), it was as insurance to put them there.

I think the video was from the hospital web-site.

Wally
Posted 3/21/2013 11:52 AM (GMT 0)
My seminal vesicles were termed suspicious from a CT scan and my HDR Brachytherapy did reach them as well as the IMRT. I can not speak for seeds.
Posted 3/21/2013 12:01 PM (GMT 0)
Good question.
Posted 3/24/2013 12:17 AM (GMT 0)

Wally 1960,

I did a search to find the video but was unable to find it.  Have no idea if one seed placed in the seminal vesicles would be enough to kill the cancer.  If you can find the url for the video please post it. 

JNF,

Looks like NONE of the LDR brachy guys had suspicion of SVI involvement.  My thought was to have IGRT and then have LDR brachy at the Chicago Prostate Treatment Center.  But your input points to the HDR brachy treatment if there is suspicion of SVI involvement.

Buddy Blank,

Good question with only useful help from JNF.  Disappointing, especially when I have read so many posts bragging about LDR brachytherapy.

Thanks,

Phil

Posted 3/24/2013 3:48 AM (GMT 0)
Have you talked to the Chicago Prostate Center?
Posted 3/24/2013 5:22 AM (GMT 0)
I haven't been treated with  Brachy just researching it.  Found this: “Patients with biopsy-confirmed seminal vesicle involvement and negative nodal involvement should have vesicles implanted. Deposition of seeds is accomplished through the peripheral needles or through 4-5 additional needles that are placed in the seminal vesicles after removal of the interior ones. The seeds are placed in the anterior and posterior walls to ensure that the prescript ion dose cloud covers at least the proximal half of the seminal vesicles [ 15 , 16 ].” here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2735748/
Posted 3/24/2013 12:34 PM (GMT 0)
Learning Quickly it seems to me that an appointment with Dr. Moran at CPC would serve you. I am sure he could answer your questions.
Posted 3/24/2013 5:49 PM (GMT 0)
Phil - sorry, I can hear the frustration in your voice. Fortunately for me I was not Dx'd with SVI so I can't weigh in directly for you.

You mentioned the CPC - I would agree with Buddy that if you haven't made an initial appointment with Dr. Moran, it would be good to do so. When I met with him we went over all my stuff and had there been any issues he would have gone with external first, then seeds as a follow-on - but again I was lucky.

I did find some information that will hopefully be helpful to you, check out the following link to an article published in 'Advances in Urology':

http://www.hindawi.com/journals/au/2009/327945/

It seems that the "radiation cloud" from HDR has better coverage potential than LDR for SVI.

Best to you and again IMHO your best bet would be to get into the CPC and discuss it directly with Dr. Moran.
Posted 3/24/2013 9:14 PM (GMT 0)
I agree with A Yooper in that you should have a little conference with Dr. Moran at the CPC. He's been performing Brachytherapy for years and I believe that he really knows his stuff. Keep us posted - please!!
Posted 3/25/2013 2:41 AM (GMT 0)

moeskeeter,

Great site containing the in depth explanation to the questions I had.  As a layman I now can appreciate and not question my RO plan of treatment. Well, not as much, as I am a 'refusenik', and as my own advocate it is in my best interest to investigate what they recommend.  But from herein I will be more at ease and defer to their highly educated decisions.

A Yooper,

The site you sent contained the same information as the one mosekeeter sent. It was full of the information I needed. I would have liked to go to the CPC if it were not for my high risk. You are lucky you caught yours earlier than me. As you say the 'radiation cloud' (not sure what that is or means) with HDR would be better than the LDR for SVI.

Buddy Blank,

I had a phone consultation with Dr Moran from CPC. 

erbob,

Hello to another old timer!  Yes, I know all about Dr Moran's great record. Would certainly go there if it were not for my high risk statistics.

Healing Well has really helped me a lot and my thanks to all of you.

Phil

     

Posted 3/25/2013 12:42 PM (GMT 0)
Hi again Phil.  The "radiation cloud" - here's a quick explanation from the prostatecancer.com website:

"Cloud of Radiation for Prostate Cancer Brachytherapy

 

A cloud of radiation surrounds the prostate gland after the organ has had the brachytherapy seeds planted as a prostate cancer treatment. The permanent seed implants create a concentrated area of radiation that can extend as far out as 5 millimeters. The cloud can treat prostate cancer that has extended into the seminal vesicles."

When they state "permanent" seed implants they are talking about LDR brachy, but again HDR will have the same effect.

The following link to the UCLA.edu website does an excellent job of providing an overview of HDR brachy for prostate cancer:

http://radonc.ucla.edu/body.cfm?id=212

If you go straight to section 7.1 it not only discusses the radiation cloud, but also pictorally shows the cloud surrounding the prostate gland as well as into the SV regions.

Sounds to me like you've come up with a good plan with IGRT and HDR if you have SVI.  When I was in that part of my journey learning about the various treatment options - once I settled on brachytherapy I was comfortable with either HDR or LDR.  I chose LDR primarily because of the remarkable post treatment results of Dr. Moran and the CPC; my choice for HDR was going to be Dr. Jeffrey DeManes at the CET/UCLA. 

The point I would like to make is that I decided no matter, or where, I was going to be treated by "the best" practitioner; I didn't care if that involved long distance travel and staying wherever the treatment center was as long as it took - we're talking about my life, and my quality of life.  While not independently wealthy I was prepared to deal with that - second.  I was fortunate in that I am only an hour or two away from the CPC so that ultimately made the decision.

Best to you Phil - stay focused and strong, no reason to believe you won't be one of the next one's to kick this beast's ***.

Posted 3/25/2013 6:21 PM (GMT 0)

A Yooper,

Wow!  Great site from ucla. 

What makes me nervous (and full of anxiety) is the position of the seminal vesicles upward from the prostate and right between the bladder and rectum.  As a dummy I don't see how they can get the 'radiation cloud' to extend up there without it also possibly affecting either/or the rectum and bladder.  But I guess that is why we pay big money to the RO to figure this out along with how much Grays to use.  BTW I see you PSA is now at what I have read is a 'cure' level.  Congratulations!  Must be a tremendous relief for you.

I hope Mayo is as good at the HDR Brachy as UCLA.  Tried to find out their information on HDR but haven't had any luck on such things as how many they have done, results for high risk, etc   They do have some very highly educated doctors but they don't put out good info like CPC and Datolli in Sarasota, Florida does.  So you just have to pretty much go on their reputation.

In the little time I have been on HW I notice you are considered one of the 'experts' on seeds, so it is great to hear from you!

Keep posting....you help new guys a lot.

Thanks,

Phil

Posted 3/25/2013 6:28 PM (GMT 0)
I almost went to UCLA for HDR. They have an outstanding program.
Posted 3/25/2013 6:55 PM (GMT 0)
Hi again Phil,

I found more information on seed implanting the SV's:

http://www.ncbi.nlm.nih.gov/pubmed/17284384

http://www.sciencedirect.com/science/article/pii/S0167814001003723

For this next one, go to the 2nd to the last paragraph of section 3.1:

"Patients with biopsy-confirmed seminal vesicle involvement and negative nodal involvement should have vesicles implanted. Deposition of seeds is accomplished through the peripheral needles or through 4-5 additional needles that are placed in the seminal vesicles after removal of the interior ones. The seeds are placed in the anterior and posterior walls to ensure that the prescription dose cloud covers at least the proximal half of the seminal vesicles [15, 16]."  Here's the link:  http://www.hindawi.com/journals/au/2009/327945/

Hope this provides more input for you - and trust me, if you start to feeling like you're getting "paralysis by analysis" don't worry about it - it's a good place to be!!!

Continued best to you - keep on keepin' on with this!

Posted 3/26/2013 2:22 PM (GMT 0)

Hi A Yooper,

You write:

"The point I would like to make is that I decided no matter, or where, I was going to be treated by "the best" practitioner; I didn't care if that involved long distance travel and staying wherever the treatment center was as long as it took - we're talking about my life, and my quality of life. While not independently wealthy I was prepared to deal with that - second. I was fortunate in that I am only an hour or two away from the CPC so that ultimately made the decision".

I agree with you.  I am far from wealthy also.  Mayo is a five to six hour drive for me each way.  Wish it was closer as it is fatiguing at my age.

I picked Mayo because they have 22,000 prostate cancer cases a year and have a great reputation.  I expect them to do the IGRT and HDRT Brachy

well.  If my starting PSA of 164 didn't put me in high risk I would have chosen CPC like you.  I can get a direct flight to Chicago from where I live, so it would be easy to do.

The sites you sent me answers my questions well.  I sincerely thank you for the time and effort you put into your post on my thread.

Phil 

Posted 3/26/2013 4:44 PM (GMT 0)
Phil,
Good luck in your treatment. You went through an extensive staging process and have a good idea of your status. You picked the treatment that gives you the best results for your individual status and also picked one of the best "artists" for your treatment. All patients should take a page from your playbook.
JT
Posted 3/27/2013 12:47 AM (GMT 0)

John,

Good to hear from you.  You helped me quite a bit with your 'analytical'

mind.  Remember, you referred me to HW when we were on the Inspire Forum of UsToo Prostate Cancer Support.  You told me HW was your favorite forum and to post my question there.  For that and your email help I thank you.  You and good old Chuck Maack are two of the best

mentors that I know of.  You two and the forums and four good books helped me learn all I know about my PCa (which is very small compared to what you two know!)  Many thanks!

Phil

✚ New Topic ✚ Reply