Met w/ Radiation Oncologist

today at St. Joseph's/Emory.

He was very helpful and talked with us for about an hour. He suggests two treatment options for me, within the next 3-6 months at most, based on my Gleason score (7), PSA (4.6) and age (48):

1. Robotic Surgery

2. Brachytherapy

1. LDR Seeds
2. HDR Brachy

He suggested the SE's for each would be very similar, all things considered. He's not a surgeon, but said surgery would be an excellent option for me and the SE's would be more pronounced on the front end, just as many on here have said.

He predicted a 25% probability of ED for me, regardless of which option I choose. Incontinence would be low probability he said, around 1-2%. Urinary irritation with seeds could last four months but with HDR about a month, and a 2-3% chance of longer term issues with that.

He put me at the low-intermediate risk group, and further explained my Gleason scores, etc. I think I'm reading it right, but I had four cores of the 12 positive.

He's the chair of the dept. at St. Joseph's/Emory and named several places he'd recommend for this procedure; UCLA, Duke, etc. including him doing it at Emory.

I'm leaning toward the HDR Brachytherapy as he showed me the 15 year data and it looked pretty impressive. He did speak highly of surgery and said they (surgeons) typically don't keep data as far back or detailed mostly because of the nature and difference of their procedure compared to Brachy (they've sort of HAD to document as they were the 'other' method, so there is typically more data).

He was a little surprised I knew anything about HDR Brachytherapy as most don't and it doesn't get a lot of advertisement. I told him about this site and a couple of posters who've had good results going this way.

Somebody said...
He suggested the SE's for each would be very similar

I'm kind of surprised that he said this. I've been led to believe that the urinary SEs are opposite for surgery versus brachy in that incontinence is more common with surgery than with brachy, and that difficulties such as uretheral stricture are more common with brachy than with surgery.

So, with surgery you could be leaking, and with brachy you might have a weak stream.

I also remember reading somewhere that a higher intensity radiation delivered over a shorter time period (as in HDR brachy or SBRT) is more effective at killing prostate cancer cells, and less damaging to healthy cells than a lower dose delivered over a longer time period (LDR brachy or external beam radiation).

Please jump in if anyone has learned differently on this...

Hawaii-Guy said...

Somebody said...
He suggested the SE's for each would be very similar

I'm kind of surprised that he said this. I've been led to believe that the urinary SEs are opposite for surgery versus brachy in that incontinence is more common with surgery than with brachy, and that difficulties such as uretheral stricture are more common with brachy than with surgery.

So, with surgery you could be leaking, and with brachy you might have a weak stream.

I also remember reading somewhere that a higher intensity radiation delivered over a shorter time period (as in HDR brachy or SBRT) is more effective at killing prostate cancer cells, and less damaging to healthy cells than a lower dose delivered over a longer time period (LDR brachy or external beam radiation).

Please jump in if anyone has learned differently on this...

It could very well be that I didn't remember it exactly right so let me put it this way: the SE's I am most concerned about will be about equal was the thing I walked away with.

The urinary issues he explained were almost rare, like <5%, so I might not have listened as closely to what he said on that. He did talk about the issues you mention above but like I said the odds were low. And he was discussing the "low-intermediate cases" and we looked at the data and charts for that group.

JNF said...
Dewayne,

Sounds like a good visit.   As you know I am a proponent of HDR brachytherapy and was one of the first regulars on HW to use it.   I have had absolutely no urinary side effects and my stream is better than ever and I am 15 years older than you. 

 

A very good friend of mine had HDR at St. Joseph's five years ago.  At the time he was 68, 50 pounds overweight, serious diabetic, high blood pressure, a real mess.   He came through wonderfully and has since always had undetectable PSA, gotten control over his weight and made improvements in all areas.   He credits the docs there for turning him around.   We often compare notes and he reports absolutely no urinary issues.

 

The only reason I didn't use St. Josephs is that my urologist works with another HDR brachytherapy clinic.

 

Jack

Thanks Jack.  I have an appointment with the same urologist you used, Dr. Kriteman, in mid November, at his Roswell office.

Dr. Rossi (St. Josephs) said he doesn't do the 'Cyberknife' on guys younger than 60; and while it looks promising there's just not enough history for him to change that yet.

Sure sounds like a good consult. All the choices were presented with his opinion on the pros and cons. And I agree that you likely will be cured with any of these.

I'm also an HDR brachy guy and it's worked well for me so far. But I don't necessarily want to advocate for it since, as I said, pretty much everything will work. I will say that if you are looking for more HDR brachy info that there's several of us here and we're available to answer any questions you have.

Good luck, Dewayne!

Good meeting! If JNF recommends a good local HDR guy, I would certainly want to meet him. There's been a lot of experimenting with different HDR treatment protocols lately (ranging from 1 treatment to 6), and it's not at all clear yet if any one is better than the others. High cure rates, extremely low side effect profile, and many years of data.

I agree with Samster - keep going! You can take time to do the interviews, and be absolutely sure before you commit yourself. Did I mention CyberKnife at Wellstar Kenneston?

Dewayne,
It does indeed sound like you were able to get an objective assessment of your situation. Now you can make a decision based on facts rather than fear. That is all anyone can realistically expect, unfortunately, many never get it. I think that your inclination towards HDR brachy is an excellent choice. I had LDR and could not be happier, but I have since learned that HDR may be even better.
I wish you the best.

nuttinhoney said...
DeWayne - I am curious why your doc did not mention IGRT or did he?

Nuttinhoney,

The doctor talked about that but honestly I can't recall his reasons exactly for recommending brachytherapy.

It might have been b/c he said I was low-intermediate or maybe my age? I just don't recall. He does that type, plus the cyber knife but he gave me some reasons for his recommendation.

Sorry.