HDR brachy vs SBRT

Suzhtz: HDR and SBRT are both excellent choices with about the same cure rates. If you have wondered through our search window and plugged either of these thearapies in you will see fewer comments but good success rates.

I chose LDR over these two because it has been around a lot longer and therefore had up to 15 year and better survival data. Also, there is more info available on long term SEs.

Other very knowledgeable SBRT and HDR folks will add to my thoughts in short time. I wish you well what ever your decision and keep us updated.

Thx for the feedback, browntrout & Jim.

Slowly but surely, Steve is whittling down the treatment options. We have two appts at the Cleve Clinic on Thursday. SBRT in the morning & surgeon in the afternoon. Also are meeting with Dr Mani Menon in Detroit on Sept 9.

There might be more concern with LDR in our situation. We have a 6 month old grandson & another son & DIL who are trying to get pregnant. The idea of being "radioactive" makes Steve a little nervous.

Michael - We'll know more about the "backyard" SBRT program after Thurs. For HDR, we'd probably consider Martinez in Michigan.

That's exactly the decision I faced. I had the two of the top practitioners at my doorstep- Demanes for HDR, and King for SBRT. The two treatments are radiologically identical - in fact, SBRT was designed to imitate HDR. There is perhaps a bit more acute urinary irritation with HDR because of hot spots, but the difference is minor. So based on oncological control and toxicity, there is no basis to decide.

HDR had a longer history. I think Demanes/Martinez had already published his 8-yr f/u. SBRT had only a few 3 year studies back then in 2010. However, the length of f/u did not faze me because, as I studied radiobiology, it seemed to me that SBRT was mostly just a variation of HDR (and an improvement over IMRT) rather than an entirely new thing. I looked at it as buying the latest model. Still, theory is one thing and practical application another thing entirely, so HDR had the advantage on this dimension. Now that there is a large 7-yr study on SBRT too, that advantage dissipates.

One other consideration for me was cost. SBRT was available to me on a clinical trial, which translated to bargain basement cost ($9,000) and assured insurance coverage. Even outside of a clinical trial, SBRT is cheap, although not as cheap as LDR. HDR was quite a bit more expensive including costs for anesthesia and two overnight hospital stays. My insurance would have covered it as well.

But what finally decided it for me was sheer laziness. HDR involved something of an ordeal - two overnight hospital stays a week apart, anesthesia, and recruiting friends to help me. (BTW - Martinez does it in one visit, I think). SBRT involved 5 ten-minute sessions with no fuss or bother at all, other than fiducial placement.

If I had it to do over, I would have probably done Active Surveillance for however long I could (probably a couple of years at most), and then done SBRT. The only lingering symptom of treatment is loss of ejaculate.

- Allen

Suz, and Steve, i'm not going to comment too much since i am very partial to surgery. I'm sure if my outcome had not been as lucky as it has been, i might be thinking differently, but for now, i have an admitted bias. And i only know what i have read here, regarding SBRT and HDR, which both seem like very viable treatments, albeit with RELATIVELY short histories. Although not so short relative to Da Vinci surgery, i would surmise.

But i did want to complement you on your amazingly thorough and methodical process of traveling down this road and exploring every option. It will serve you very well in the long run.

So good luck, whatever you decide, it will be the right decision.

Suz-
You may have read comments I made about visceral fat and its protective effect on the small bowel during pelvic lymph node treatment. It may have some protective effect on bladder and rectum as well, but I have never seen that mentioned in the literature. I have six-pack abs (well, a 4-pack if I am completely honest) and have not had a problem. In any case, that is all handled in the planning phase - there are strict dose constraints that are followed.

I never look for any doctor's recommendation of one treatment over the other, UNLESS he is saying that his own therapy is less preferable. Doctors (with some exceptions) tend to know little about specialties outside of their own. And that's especially true between surgery and any kind of radiation, in my experience.

Works Out - Steve is also a G7 (3+4), so ins approval might come into play with SBRT. I hope not as we don't want to fight that battle, but I'm ready to "go to the mattresses" if necessary.

Allen - Your posts are as good as/better than reading studies, so I may have gotten that from something you posted.

Nomar - I called Medical Mutual last week and they said they needed the 5 digit procedure codes, which we hope to get from Cleveland Clinic on Thursday. The Medical Mutual plan we're on is partial to the Clinic, so that could help. Step 1 would be getting it approved thru the Clinic, then hopefully, that approval would carry over if we chose to go "out of network". This is new territory for us, so we are learning as we go.

I know Anthem got some negative press on denial of SBRT but I also recall reading that Anthem in NJ may have recently approved it. It may have been two totally different ins companies though.

zerocancer.org/sbrt

Hi Suz,

I totally understand trying to weigh all the options. It can be overwhelming, can't it?

My husband had HDR at UCLA in June. This was after reading tons and tons of research and consulting with many doctors. Of course, this forum was beyond helpful -- I am forever grateful so many of you all.

Ultimately, I think it was going to be between SBRT and HDR, and it was a really close call. I think either would have been great, along with surgery maybe/probably on the latter (there was some question about microscopic extension). My husband posted about his experience, so you can do a search for JinPA. And don't hesitate to drop me a note if you want to talk or you want to speak with my partner.

I wish you (and everyone here) all the best with this.

Warmly,

Mary

Hi Suz,

Honestly, doing the HDR over SBRT was more of a gut thing than anything else. It was an extremely close call. We did see a person at Georgetown about SBRT, and we liked him very much. There is also a forum for cyberknife and prostate cancer where Dr. Katz is active, and that is helpful, too (google cyberknife, and you'll see the forum). Also, Tall Allen and many others on this forum were fantastic. I am so grateful. I also corresponded with some folks on the Inspire forum, and they were helpful.

In terms of traveling to UCLA, a couple of things played a role there. First, we had corresponded with Dr. Kamrava several times re: the HDR, and we found him very responsive and helpful. We felt comfortable with him and with all of the folks at UCLA. We also were interested in being at a major cancer center and teaching hospital. We did try to see what the schedule was like at Emory, but they were pretty booked at the time, and we were starting to really want to get things treated and to try to move on. We found the folks at UCLA just wonderful -- kind, expert, experienced, everything. Also, getting to stay at the Tiverton house was key -- really reasonably priced, close, just perfect. We also got a chance to hang out with Allen a couple of times -- GREAT! Thanks Allen!

Suz, I can totally relate to the struggles in making a decision. I am almost OCD when it comes to info seeking, and it's just dizzying when there are so many options. Once you decide and have a little space, it will get better. I also have relied heavily on the power of both exercise and meditation (and yea, wine doesn't hurt! :) ).

I told John about your post, and he is more than happy to talk with you or your partner, as am I. I'll see if I can get him to post, too.

My warm best to you, Suz.

Mary

Mary - Thx so much for taking the time to go into more detail on how you reached your decision. You covered many of the points and considerations Steve & I have discussed. Many people think we are just plain nuts to consider traveling for treatment when the Cleveland Clinic is less than 40 min from our front door, but it is critical to have a comfort level and confidence in your treatment plan and provider. So far, we've only had that experience with one doc at the Clinic who does LDR, and, for various reasons, Steve has pretty much ruled that option out. His top three options are SBRT, HDR & surgery, in that order.

You are so right about the exercise and meditation -- and the wine! Steve has been going to a Monday night yoga class that ends with a 20 min session of meditation. It has helped him tremendously and he is not a yoga kind of guy. He was having so much trouble sleeping, which is totally understandable, but the meditation techniques have really helped with that.

Julie - Thx for chiming in! I totally get that "down-time" consideration. Steve owns and runs a construction co. He's very hands on and his days can include a lot of physical activity. I'm sure that is why surgery is #3 on his list, and why SBRT is #1. That is so great about your husband's PSA!

Thx for sharing, ladies! It's definitely a man's world here -- but they have all been so open, helpful & welcoming that I sometimes forget that.

Suz