HDR Brachytherapy +IMRT + HT

I have decided to undergo HDR Brachytherapy with Dr. Demanes at UCLA along with 25 sessions of IMRT with Dr. King at UCLA. Dr. Demanes gave me the option of having 3 fractions of 7.5 grays in one session over 2 days with an overnight hospital stay with the delivery rods kept in place the whole time, or in 2 fractions of 10 grays given in an outpatient setting in 2 sessions with the second fraction a week later. He says the efficacy and SEs are about the same. You trade the hassle of 2 separate visits and 2 separate surgical procedures, along with a spinal block and anesthesia, for not having to spend 8 hours trying to sleep in a hospital room in a very uncomfortable situation where you cannot move.

Because recent studies seem to show that smaller fractions of higher dose radiation are more effective treating PCa while reducing the overall dosage, and, because I am a bit claustrophobic, I chose the 2 outpatient sessions. I have a couple of days to change my mind so I thought I would ask the forum for their opinions.

I also wonder if a week between the 2 fractions is better in that it gives the healthy tissue more time to recover or worse because it gives the PCa cells time to recover.

I believe in the earlier days of HDR, there was a debate between the Demanes protocol of more fractions of less dosage and the Martinez protocol of less with more, but I could be wrong. If anyone has anything to share to this. I would greatly appreciate it.

Jack, I have no input re your question but I do want to wish you the best. You have certainly done your homework, picked an "artist" and should expect great results.

Good luck and please keep us up to date.

Jim

The whole HT thing is very confusing to me. I feel Dr. Demanes thinks it is unnecessary but doesn't want to step on anybody's toes. My oncologist, Dr. Scholz, feels I should be on the heaviest HT for 18 months and, in addition to adding the Lupron to the Casodex, he wants to add Zytiga.

I told him I would commit to 6 months and then see how I feel then. For every study I find showing a benefit, I find another saying it is of no extra benefit. If the cancer is already systemic, it may be a long term struggle anyway, but if it is localized, I may be doing myself more harm than good. I'm sure others have struggled with this question for which there is no easy answer...

F8,
Did Andy Grove have HDR BT or the LDR seeds? The article was a little confusing. I also see he had short term HT.

Did you have any evidence of ECE?

Jack

ed - ECE is "extra capsular extension", which means that the tumor has penetrated the capsule wall. It can still be considered localized if it has not metastasized. The ECE is the reason Scholz wants to throw the kitchen sink at it.

Jacksan -- I answered in my above post. we did assume that the PC was out of the capsule and hence the combo treatment. I probably would not second guess Scholz. I would have done more HT if they had requested it.

ed

Hi Jack,

I was an early user on the board of HDR more than three years ago.   My decision to use it was greatly based on the information from Dr. Demanes.   I am in Atlanta and had two great choices so I didn't have the travel.   I used the system on the two procedures one week apart.   I did not think it was a hassle at all and I am sure I would prefer it over the hospital stay.

As to the HT, mine was a no brainer due to my high risk situation.   Yours is not so clear cut and it sounds like a "better safe than sorry" situation.   I would think your HT would be short term in nature 6-12 months.   I strongly suggest you talk to your docs about taking Jalyn.   It combines Avodart with Flomax.   The Avodart is a known cancer fighter and the Flomax helps urinary function through the radiation.   The Jalyn combination makes each drug more effective than on their own.

Let me know how I can help as I have been through what you are doing and I have done great.

Jack  

Jacksan -- I don't have any long term SEs from HT that I'm aware of but I was only on Lupron for nine months.

ed