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Recently diagnosed - leaning toward LDR brachytherapy

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Posted 4/28/2014 4:58 PM (GMT 0)
I was recently diagnosed with prostate cancer. Based on my history and indicators, I think I am intermediate risk instead of low risk. I don't know why I would go Active Surveillance before getting it treated - it's not going to improve. Based on all the reading that I have done I am favoring LDR brachytherapy (day procedure, minimally invasive, quicker recovery, better continence, lower ED, etc).
Two questions:
1) I have advanced osteoarthritis in both hips so I don't have much hip flexibility. I am a candidate for a hip replacement at some point in time. Will the lack of flexibility be a problem for brachytherapy treatment or will the anesthetic / spinal take care of this problem?
2) Is there something that may cause me to regret my choice of LDR brachytherapy? I also had a heart attack 15 years ago so I'm not sure if that impacts my treatment choice.
Posted 4/28/2014 5:21 PM (GMT 0)
You have to register for free to view this but here is a video of Dr. Mack Roach in 2013 speaking about Brachy. Surprised me how long it has been around

askdrbarken.wordpress.com/2014/04/27/dr-mack-roach-iii-radiation-onc ology/

LupronJim
Posted 4/28/2014 5:46 PM (GMT 0)
welcome to HW, sorry you need to be here.

Brachy is a good choice. I have a brother with lots of medical issues and all his doctors finally decided it was the best way to go. He did fine - a single treatment and his PSA dropped like a rock. Worked great for him

You might rule out surgery - it can be a concern for a cardiac case but it's possible.
Bean radiation is possible but with your hip issues that might be uncomfortable having to get on and off the table every day.

Placing the brachy seeds isn't any more difficult that doing the biopsy - they go in the same route. If you tolerated the biopsy, I'd think you'd do fine with brachy. They'll likely do a general anesthetic but talk to your doc about any special needs you might have. You might want to have a talk with your cardiologist about the anesthetic choice but likely you'll be fine with a general.

Hang in there and keep us updated on your progress,
Andrew
Posted 4/28/2014 6:06 PM (GMT 0)
I had the surgery and my brother had the seeds. He seems to be doing well after 6 years.
Posted 4/28/2014 6:17 PM (GMT 0)
Hello Canuck and welcome to HW. Sorry you have to be here but you will find a lot of good support and info on this site.

I would recommend that you read the sticky thread at the top of our forum that is designed for newly diagnosed patients. Hopefully this will be of help to you.

Most any treatment should cure you given your stats. However, I would recommend that you get a second opinion on your biopsy slides to make sure of your diagnosis. Use someone like Dr. Bostwick of Bostwick Labs or Dr. Epstein of JHU. It may cost you extra since you are not in the USA but it's well worth it to have your slides read by an acknowledged expert.

I would highly recommend that you seek multiples opinions from different and unrelated doctors. Look at surgery, HDR and LDR brachy SBRT, etc. You want to make sure you research this thoroughly before pulling the trigger. Whatever you finally decide, make sure your doc has several hundred of procedures under his/her belt because experience really does count!

Having said the above, I am personally a big supporter of LDR brachy; if you copy and past the link in my signature you will see why. I see no reason the medical issues you raise should be an issue with LDR brachy.

Good luck in whatever you finally choose and stick with us.

Jim
Posted 4/28/2014 6:34 PM (GMT 0)
Allan,

Welcome to the Forum and sorry you have to be here.

LDR brachy is a great therapy and much underutilized, imho, especially for low risk disease.

With your intermediate risk disease - stage T2b/c and Gleason 3+4 are both intermediate risk features that put you squarely in that camp - some seed specialists would want to supplement the seeds with some external beam radiation, especially considering your high cancer volume. The outcomes are better, but the side effects increase.

The main caution I would offer is to get it done by a VERY experienced specialist who has a great track record. It seems to be as important as picking a great surgeon for an RP -- it can make a huge difference. Think of trying to push a staple-sized needle into something with the consistency and deformability of jello and getting it to stay exactly where you want to place it - that gives you some idea of the artistry involved in seed placement. It is easy to get wrong - cold spots (where placement is lacking) may be sites of recurrence, hot spots (where too many seeds wind up) can cause toxicity. Seeds can migrate. If you decide to go this route, I recommend going with one of the top LDR brachytherapists. In Canada, I've heard of a good one in Vancouver, but I don't know of any in Calgary. In the US, there are several well known seed artists who almost always get great results.

There is another kind of brachytherapy - HDR brachy - that doesn't leave anything inside. It is less dependent on the artistry of placement because more than a dozen catheters hold the prostate in place, and it is done under CT guidance. It can also be used effectively as a monotherapy for intermediate risk. Once again, the problem is access, because you can't find it everywhere.

SBRT (e.g., CyberKnife), which is radiologically based on HDR brachy, is less dependent on the skill of the RO. I don't know if Calgary has any.
Posted 4/28/2014 6:54 PM (GMT 0)

CanuckGuy51 said...
I was recently diagnosed with prostate cancer. Based on my history and indicators, I think I am intermediate risk instead of low risk. I don't know why I would go Active Surveillance before getting it treated - it's not going to improve. Based on all the reading that I have done I am favoring LDR brachytherapy (day procedure, minimally invasive, quicker recovery, better continence, lower ED, etc).
Two questions:
1) I have advanced osteoarthritis in both hips so I don't have much hip flexibility. I am a candidate for a hip replacement at some point in time. Will the lack of flexibility be a problem for brachytherapy treatment or will the anesthetic / spinal take care of this problem?
2) Is there something that may cause me to regret my choice of LDR brachytherapy? I also had a heart attack 15 years ago so I'm not sure if that impacts my treatment choice.

LDR Brachy is one of the focal therapies I thought about, but eventually went for cryo (see my topics here & also my profile for my blog).
Brachy sounds like it is quite a similar focal therapy to the cryo I had.
If you look at the videos on my blog, you'll see that the position they put your legs in isn't asking any special flexibility (or so I would have thought). Anyway, that IS all done under general for most focal treatments, I think, so you won't know it's happening.
In the UK here, we normally have a hospital pre-assessment, which includes an ECG, so assuming you have those in your country, they should highlight any cardio problems in advance, and, I guess, take them into account.
Posted 4/28/2014 7:49 PM (GMT 0)
Andy, I would not consider LDR brachy a "focal" therapy. Focal, such as yours and Ziggy's, really just goes after destroying the tumor and close immediatel tissue. LDR brachy, on the other hand, plants seeds THROUGHOUT the prostate, and the entire prostate and surrounding tissue is irradiated. In other words, my prostate is pretty much mush after the radiation did it's job...

JIm
Posted 4/28/2014 8:16 PM (GMT 0)
JIm,

There are a number of treatment options that are waiting in the wings for use in Focal therapy if Focal therapy becomes a more widely accepted option. Brachy is one of them. Here's a paper about the potentials if offers: www.ncbi.nlm.nih.gov/pmc/articles/PMC3775638/
Posted 4/28/2014 8:59 PM (GMT 0)
Peter, that's great info...first I had heard about LDR brachytherapy as potential focal therapy. It makes sense.

Thanks,

Jim
Posted 4/29/2014 1:47 PM (GMT 0)
I am favoring LDR brachytherapy (day procedure, minimally invasive, quicker recovery, better continence, lower ED, etc).

Canuck,
Agree 100%. Can't comment on the hip issue, but nearly 5 years out, not one regret. Instead, I am thankful every day that I made a choice that not only fixed the cancer, but allowed me to live my life as I did before.
God Bless.
Posted 4/30/2014 3:20 PM (GMT 0)
I had HDR brachytherapy and would sugget you look at it as well. I chose it over LDR seds at a premier center here in Atlanta. It is higher tech than conventional seeds in the placement method and the radiation dose delivery. Its advantages include radiation that better conforms to the cancer and no radiation is left in the body. Best website is www.cetmc.com by Dr Jeffrey Demanes at UCLA, the pioneer of HDR brachytherapy.
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