Brachythearapy questions?

browntrout said...
I realize there is no perfect treatment and all offer their own risk-reward scenarios. I am almost settled in on BT when research reveals some red flags (questions): Any thoughts would be greatly appreciated.

1. All RTs can (some say will) harm healthy tissue which can (some say will) cause cancer in other areas down the road.
2. There are few (some say none) salvage options should BT fail.
3. I have seen BT survival rates from as low as 30% all the way to 90+%.
4. Since I have at least one G 3 + 4 is BT + EBRT the correct choice?
5. All RT treatments could leave missing cancer cells that will eventually grow, i.e. recurrence as opposed to RP which removes the prostate.

I'm assuming that your other choice is surgery and you're right there is no perfect treatment. I can't answer those questions but I can comment on my treatment(s)......if I had to do it all over again I wouldn't change a whole lot !

Dear Trout:

Re your questions:

1. Of course the brachy will destroy the healthy prostate tissue along with the cancer. However the chances of it causing a secondary cancer are extremely low...kinda like the odds of dying during a prostate surgery...so low that it's not worth serious consideration IMHO.

2. Not true. There are just as many salvage options after a failed brachytherapy as there are after a failed surgery...they are just different. Salvage surgery is possible by a highly skilled and trained surgeon but, frankly, I would never do that myself because I think there are better options like seeding with a different isotope, HDR brachy, cyrotherapy and HIFU.

3. Yeah, you can find cure rates all over the board depending on who sponsored the study, what the definitions were, etc. After reading literally hundreds of studies myself I have concluded that surgery and LDR brachy provide approximately equal cure rates but with brachy generally having an edge with a better chance of less onerous SE's. If you are seriously considering brachy, one of our members who had brachy more recently that I did has some excellent documentation. His name is AYooper. His HW email is still active or you can email me and I will provide you with his email address.

4. I was also a 3 + 4 with only a few cores and low % in each core. Adding IMRT adds more certainly but also adds the possibility of more SE's. I chose brachy only but that may not be for everyone. If I was doing it again today I would insist on a multi-parametric MRI or color dopplar prior to the procedure so that I had the best possible info.

5. A brachy done correctly should not leave any more cancer cells than a surgery done correctly. In fact, the brachy radiation can be placed to extend slightly outside the capsule so as to kill any little buggers who have slightly escaped.

FULL DISCLOSURE - I clearly have a bias toward brachy for those patients who are qualified for it. Read the link in my signature about my journey to understand why.

Good luck,

Jim

Trout

I was in a similar situation as you. It was a difficult decision. I guess that due to the long delay in diagnosis, you could say I had the luxury of plenty of time to make my decision. Anyway that being said I decided to have LDR brachytherapy and IMRT. Even though I had only 1 core with a small percentage of 3 + 4 I wanted to hit the cancer hard. My treatment also included zapping the pelvic lymph nodes on the slim chance that a few cancer cells had escaped. I have had virtually no side effects from my treatment. I give all of the credit for that to my skilled doctor and his team. As with any treatment there is no guarantee but so far numbers have been great.

Others have answered your questions accurately. I would add two comments: there are many studies on radiation and secondary cancers and none have shown any secondary cancer risk due to brachy. There is a slight additional risk with external radiation.
Question #5: radiation makes the prostate tissue and bed fallow, which means that new cancers cannot grow. The biggest reason for failed local external radiation radiation is too low a dose. Brachy gives a much higher dose. The largest cause of brachy failures is dead spots due to seed placement. Modern imaging and a quality control CT scan two weeks after the procedure to verify seed placement has all but eliminated this early issue.
I had both brachy and external radiation and have no side effects at all after 5 years and psa all at 0.1 Traveling for a brachy procedures is pretty easy, so if your area does not have an experienced brachytherapist I would travel to get one of the better ones, Dattolli is Sarasota, Moran in Chi, or Grimm in Seattle. It's about a one hour treatment and you can resume daily activities the next day with few issues. Urinary frequency and urgency are common for 4 to 6 weeks and are tolerable.

Hello Brown trout, sorry for my late reply, just got flown out from 8 days in the Canadian bush. As Tudpock mentioned I do have a significant amount of info and stats on LDR Brachy that I would be happy to share. You can email me by clicking on the envelope under my A Yooper handle in the upper left corner of this post.

NW Ontario, Meandrine Lake.

A Yooper: Thank you for taking the time to help a stressed out man in need. You and the others on this forum are wells of knowledge and experience that give us the tools necessary to make one of the most important decisions in our lives.