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What if LDR brachy should fail?

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Posted 2/8/2015 9:17 AM (GMT 0)
I know that I should not be thinking about failure at this point. BUT!

My cancer is right on the margin of the right side and I know that the radiation will reach 3mm beyond the capsule, so hopefully it will kill everything. But of course there is always a chance it may not. If that were the case what would my options be?

Good morning America. Have a great day turn
Posted 2/8/2015 12:22 PM (GMT 0)
Casper, I'm not a radiation guy but I am pragmatic. I see nothing wrong with planning (researching) for a treatment failure. I don't obsess on it but I'm certainly learning all I can so as not to be blind sided if /when the day comes. After 30 years in the military contingency planning, operational risk management whatever you like to call it comes as second nature to me and in my opinion is beneficial. Like the Boy Scouts say: "Be Prepared". If treatment doesn't fail it's a bonus and you've educated yourself some more!

Cheers, Doug
Posted 2/8/2015 12:32 PM (GMT 0)
I can only tell you how I looked at it, Casper. I went with what I thought was the best-first option with no thought about 'what if fails?' Of course, one of myths has always been that once seeded, a prostate cannot be removed. That has been rebuked here many times, but is sometimes still quoted. When my oncologist told me that I had a 90-95% chance of being alive in 15 years, I joked and said that I had a better chance of dying on my Harley. He got very serious and replied, "Yes you do: stay off that thing."
I guess the point is that nothing is guaranteed. I went with the option that gave me at least as good a shot at beating the disease as any other while leaving me intact. Five years later, that is precisely the way it worked.
Posted 2/8/2015 4:32 PM (GMT 0)
Well, after a biochemical failure (nadir+2), they have to determine if it's a local failure (most are not). Some are using an mpMRI-targeted biopsy for that. Then they can retreat focally with more seeds in the affected area, focal salvage HDR brachy, focal salvage SBRT, focal salvage cryo, focal salvage HIFU, etc. The odds of a local failure for low risk guys is about 1 in 100, so I wouldn't lose sleep over this.

Often, with seeds, they do a follow-up CT scan a month after placement to give a chance for the edema to go down and the seeds to stabilize to see if there are any cold spots that need adjusting.

- Allen
Posted 2/8/2015 5:08 PM (GMT 0)
I'll bet you a beer (chilled like an American beer or somewhat less chilled like one of yours) that this will never be an issue for you. Your sense of humour is simply too good to ever allow a recurrence...
Posted 2/8/2015 5:18 PM (GMT 0)
My DH's RO told him they could do cyberknife if there was a failure.
Posted 2/8/2015 10:21 PM (GMT 0)
Thanks very much for your replies guys.

@ Shaba.Doug

Thanks Doug. Yes, I see no harm in gathering this information just in case. It is like the seatbelt in your car. You never expect too have need of it, but you always put it on. So I look at gathering this information as just that. A seat belt for my (currently frying) prostate. smhair

@ GOP.

I chose LDR for pretty much the same reasons as you (glad to see you are doing well) But have also seen that after seeds the prostate cannot be removed. I think it is because the prostate becomes very hard after seeds, therefore makes it imposable to remove safely.

OMG! I would love to own a Harley. rolleyes

@ Tall Allen.

Thanks Allen. Always the giver of definitive information. Very interesting.

I had no idea they could go back in and plant further seeds if they found “Hot spots” after treatment. I will ask my uro about that when I see him next.

Like you have advised, I will not lose any sleep over this, just thought I would ask the question out of interest more than anything. And yes, I am going back on the 25th of this month for a CT scan.

@ Michael_T

Thanks for the compliment Michael, but I have always liked to look on the brighter side of life, no matter what situation I find myself in.

So you have tried our beer then! Any temperature you like as long as it is room temperature. In fact the only time you get a decent pint here is this time of year when it is cold out.sad

Pleased to hear you are confident enough to offer me a pint if this fails. I will hold you to that and will collect if I have to return my American seeds as faulty. As long as I can get them through airport security that is. nono

@ mickey58

Interesting! I never knew that.
Posted 2/8/2015 11:11 PM (GMT 0)
Surgery is an option only when performed by a highly skilled urologist. My oncology urologist does salvage surgery post radiation, but he says it can be pretty messy due to poor margins and loads of scar tissue. And there is a higher probability of incontinence.
Posted 2/8/2015 11:33 PM (GMT 0)
You meant "cold spots." They can be especially problematic if they are in hypoxic areas. I'm glad you're getting the f/u CT scan.
Posted 2/9/2015 9:15 AM (GMT 0)

Tall Allen said...
You meant "cold spots." They can be especially problematic if they are in hypoxic areas. I'm glad you're getting the f/u CT scan.


Oppps! Sorry. Yes, cold spots. I should imagine it is already pretty "hot" in there at the moment.

Unlike with your health care I doubt I will get the results of the CT scan until I see the Uro on the 30th March. As soon as I have any further news I will report back.
Posted 2/9/2015 9:21 AM (GMT 0)

lapilot said...
Surgery is an option only when performed by a highly skilled urologist. My oncology urologist does salvage surgery post radiation, but he says it can be pretty messy due to poor margins and loads of scar tissue. And there is a higher probability of incontinence.


Thanks lapilot. After reading about this I don't think I would want to take the risk of surgery. As you say the risks are too great if the guy with the knife is not skilled at the procedure. I found the information that Tall Allen gave far more interesting and a much safer option should I require it.
Posted 2/9/2015 11:38 AM (GMT 0)
OMG! I would love to own a Harley. rolleyes

Casper yes you would, and you should consider it. Probably the most 'freeing' experience one can have...of course I haven't tried sky diving.
Posted 2/9/2015 1:21 PM (GMT 0)
GOP is right on about the Harley - go for it! I just bought a new Dyna Low Rider this past summer, and can't WAIT for winter to be done so I can get back in the saddle.

O.K. then, back to the topic of your post Prato, err, I mean, Casper. nono

This is what I wrote on another thread when this topic came up:

First of all and I think this is of merit, due to the "infrequent occurrence of unfavorable outcome... there are limited data to guide us directly when a brachytherapy failure does occur." (Quoted from "The Oncologist, the "Official Journal of the Society for Translational Oncology."

In Summary:

LDR BT: In carefully selected patients with local persistence of disease, partial LDR (125)I permanent prostate seed implant appears to be a feasible option for salvage local therapy with an acceptable toxicity profile. NCBI

Men who had seeding (brachytherapy) alone might benefit from additional seeds of a different isotope. If he had Iodine-125 seeds, he might now have Palladium-103 seeds (referred to as a "crossover isotope"), or vice versa. Dattoli

Prostate BT is an effective salvage modality in selected prostate local recurrence patients after radiation therapy. Additionally some potential predictors of biochemical control and toxicity for prostate salvage BT can be provided. Radiation Oncology.

HDR BT: Salvage HDR prostate brachytherapy for biochemical failure after radiation therapy appears to be safe and well tolerated with promising results. PCRI

Prostate HDRBT is an effective salvage modality with relatively few long-term toxicities. We provide potential predictors of biochemical control for prostate salvage HDRBT. International Journal of Radiation Oncology

Cryoablation: Can be used with recurrent cancer following radiation treatment (external beam or brachytherapy). One benefit of cryotherapy is that it is equally effective when ablating (removing) cancers of any Gleason grade. Due to the ability to use smaller needles, it may be possible to eradicate an area of the prostate that contains the cancer rather than treating the entire prostate gland. American Urological Association.

And yes, surgery after radiation is extremely difficult and rare - but, so what?

Continued best to you Casper!
Posted 2/9/2015 1:51 PM (GMT 0)
Sounds like ther may be a correlation between Harleys and PCa shocked ..... a correlation not a cause. Come to think about it there appears there may be a correlation between brachtherapy and PCa wink

Post Edited (RCS) : 2/9/2015 6:54:12 AM (GMT-7)

Posted 2/9/2015 3:29 PM (GMT 0)
I always thought that the correlation between Harleys and PC was on the curative side.

regarding the original question: My brother's doctor told us that if the LDR brachy failed, he could move to a focal beam treatment to get anything the brachy missed. However my brother's goal was at the time to just get five more years of life so we didn't worry much about the question since palliative HT could do the same thing.

Andrew
Posted 2/9/2015 3:56 PM (GMT 0)
WoW Yoops. That was a very detailed explanation and just what I was looking for. Thank you.

Maybe you should change you handle to “Tall Yooper” Like you almost changed mine to “Pratper” turn

Tall Allen has already said they can go back in and plant further seeds. I have the Iodine 125 seeds, so if needed they would use the Paladium 103 seeds. I am defiantly going to talk to my uro about this when I go back on the 30th March. Just to find out what is available on this side of the pond SHOULD my treatment fail.

I would sooooo like a Harley. Maybe I will go take a look at some when the warmer weather arrives. I have been watching an American TV series called “Counting Cars” They often have Harley's on there and when they do I just sit here and drool. tongue

When I was in Glacier Park in 2004 there was a Harley convention passing through. There was this long tunnel in the rocks and I just stood there listening to the sounds of the Harley engines bouncing off the tunnel walls as they went through. What an amazing sound.

@ GOP

I have no interest in sky diving, but would love to join you on your Harley one day. Not “Hells Angels” but “Healing Wells Angels” smilewinkgrin

Have you ever been on that Harley convention? They come from all over America and it is an annual event. Soooo cool. One guy even had his dog with him and the dog was kitted out in a leather coat and flying helmet with goggles!
Posted 2/9/2015 4:05 PM (GMT 0)

InTheShop said...
I always thought that the correlation between Harleys and PC was on the curative side.

regarding the original question: My brother's doctor told us that if the LDR brachy failed, he could move to a focal beam treatment to get anything the brachy missed. However my brother's goal was at the time to just get five more years of life so we didn't worry much about the question since palliative HT could do the same thing.

Andrew


Thanks Andrew. Your brother lives over here doesn't he? If that is the case any salvage treatment would be the same for me. I don't even want to think about HT though nono
Posted 2/9/2015 4:14 PM (GMT 0)
Well Casper, appreciate the thought about "Tall Yooper" - but there's no way I can stack myself up with our Tall One! When something comes up that I feel versed enough in I'll way in, but again TA is miles ahead of most of us out here!

And Andrew, absolutely riding a Harley is curative!!!!!!
Posted 2/9/2015 4:39 PM (GMT 0)
Casper, the same surgeon that will be part of my LDR-BT team told me in no uncertain terms that salvage surgery is an option if LDR-BT fails if it can be demonstrated with a biopsy that the failure is local (he said this is extremely rare with the present BT techniques). He has done himself a number of procedures and pointed me to this article for the technique he uses:

gucasym.org/radical-salvage-prostatectomy-radiorecurrent-prostate-cancer

He said that the operation is difficult and should be reserved for very experienced surgeons, that SE's incidence would be higher than for an ordinary prostatectomy . But it is doable and for instance they are seeing continence rates approaching 90% that are similar than for surgery as first choice. However strictures are much more common.
Posted 2/9/2015 4:50 PM (GMT 0)
Thanks vision10. I am not sure that we have many guys within our free health care system that would be capable of carrying out such a procedure. To be honest I don't think I would be comfortable going that rout either.

Thanks for the information link. I will still give it a read, because it will add to information I already have.

Good luck with your treatment plan. I hope all goes well.
Posted 2/9/2015 4:55 PM (GMT 0)

A Yooper said...
Well Casper, appreciate the thought about "Tall Yooper" - but there's no way I can stack myself up with our Tall One! When something comes up that I feel versed enough in I'll way in, but again TA is miles ahead of most of us out here!

And Andrew, absolutely riding a Harley is curative!!!!!!


But you have to admit that Tall Yooper does sound very............."Western" smilewinkgrin
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