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"Making the Treatment Decision"

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Prostate Cancer
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Posted 11/23/2014 3:00 AM (GMT 0)
I'm sure most major prostate cancer centers have something similar, but I think this free monthly seminar, complete with Q&A from a physician, is pretty great.

Some Harvard study links included as well.

http://www.emoryhealthcare.org/saint-josephs-hospital-atlanta/centers-programs/prostate-cancer/making-treatment-decision.html

Edit: it's been temporarily suspended but I wanted to link anyway.
Posted 11/23/2014 5:19 AM (GMT 0)
Dewayne,

I see you have your HDR treatment starting next month. Have you decided to get mono-therapy, or combination HDR brachy with EBRT?

That was a very difficult decision for me, I had one Dr. recommend the combo treatment, and another one recommended mono-therapy. I ended up getting the HDR mono-therapy, the possibility of additional SEs from EBRT out weighed the potential benefit for my situation in my mind.
Posted 11/23/2014 2:35 PM (GMT 0)

Hawaii-Guy said...
Dewayne,

I see you have your HDR treatment starting next month. Have you decided to get mono-therapy, or combination HDR brachy with EBRT?

That was a very difficult decision for me, I had one Dr. recommend the combo treatment, and another one recommended mono-therapy. I ended up getting the HDR mono-therapy, the possibility of additional SEs from EBRT out weighed the potential benefit for my situation in my mind.

Mono-therapy. The RO said I would ge a good candidate for mono, but they do the other treatments as well so I'm really just going with wis recommendation.

We felt very good about his expertise and desire to do what's best for me.
Posted 11/23/2014 3:01 PM (GMT 0)
Dewayne, I know you and I seem to be in a similar situation (Pratoman, Casper, etc...) and I met with my MD Anderson RO on Friday and the funny thing is that after testing (CT and volume study/mapping) and telling me I was a perfect candidate for Brachy, he said he would opt for Da Vinci at my age, etc... I thought that was interesting with him being a Radiologist. It just goes to show how personal a situation PC is. He did not discourage me in any way and I'm leaning towards LDR Brachy but he said that my Da Vinci surgeon at MD Anderson is great and he would use him if he were in my shoes. It is not going to affect my decision but it was thought provoking to me and I'm still processing the comment. He felt Proton Therapy would be his third option after Brachy due to the small amounts of radiation impacting healthy tissue and the potential length of time it had to perpetuate cancer cells. I'm glad you're moving forward and I plan to decide and schedule my treatment prior to end of this year.
Posted 11/23/2014 3:26 PM (GMT 0)
Dewayne, also, did your RO discuss the possibility of HT before the brachy treatment? Mine said it is common but did not recommend it for me. I know any combination therapy adds SE's but like all the pros on here say - "we get one shot."
Posted 11/23/2014 8:44 PM (GMT 0)
Dewayne,

I spent a whole afternoon at a university medical library researching various studies on HDR mono-therapy before making my decision. I found that HDR mono-therapy is becoming more accepted for low and intermediate risk patients. In Europe and Japan, they are also treating high risk patients with mono-therapy with good results.

Some relevant studies:

www.ncbi.nlm.nih.gov/pmc/articles/PMC4003433/
jrr.oxfordjournals.org/content/early/2013/03/29/jrr.rrt027.full
www.brachyjournal.com/article/S1538-4721(14)00505-4/fulltext

My R.O. explained that the only potential benefit of adding in a course of EBRT is to treat the pelvic lymph nodes, but there is a controversy now about whether the EBRT to pelvic lymph nodes actually does any good or not.


bigrich22,

Hormones before HDR brachy is also controversial. With LDR brachy, hormones are sometimes used to shrink the prostate before seed implant. With HDR, some R.O.s claim that shrinking a large prostate is not necessary before treatment, and some studies have claimed that adding the hormone treatment does not improve observed results.

As with any type of treatment, selecting a competent practitioner is extremely important. As one study concludes: "However, to date there are only a small number of centers worldwide that carry out HDR monotherapy. Because HDR monotherapy does not include supplemental EBRT, it requires technical maturity in terms of both implant technique and treatment planning. A special patient care protocol is also needed to manage the single implant over several days of treatment."
Posted 11/23/2014 9:29 PM (GMT 0)

Hawaii-Guy said...
Dewayne,

I spent a whole afternoon at a university medical library researching various studies on HDR mono-therapy before making my decision. I found that HDR mono-therapy is becoming more accepted for low and intermediate risk patients. In Europe and Japan, they are also treating high risk patients with mono-therapy with good results.

Some relevant studies:

www.ncbi.nlm.nih.gov/pmc/articles/PMC4003433/
jrr.oxfordjournals.org/content/early/2013/03/29/jrr.rrt027.full
www.brachyjournal.com/article/S1538-4721(14)00505-4/fulltext

My R.O. explained that the only potential benefit of adding in a course of EBRT is to treat the pelvic lymph nodes, but there is a controversy now about whether the EBRT to pelvic lymph nodes actually does any good or not.


bigrich22,

Hormones before HDR brachy is also controversial. With LDR brachy, hormones are sometimes used to shrink the prostate before seed implant. With HDR, some R.O.s claim that shrinking a large prostate is not necessary before treatment, and some studies have claimed that adding the hormone treatment does not improve observed results.

As with any type of treatment, selecting a competent practitioner is extremely important. As one study concludes: "However, to date there are only a small number of centers worldwide that carry out HDR monotherapy. Because HDR monotherapy does not include supplemental EBRT, it requires technical maturity in terms of both implant technique and treatment planning. A special patient care protocol is also needed to manage the single implant over several days of treatment."

My combo treatment with HT was to weaken the Cancer Cells by way of starvation and thus less resistant against radiation.
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