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Posted 9/17/2015 2:10 PM (GMT 0)
OK,men, so what about HDR Brachy. To read the literature there aren't many downsides other than it is initially a real pain in the ass. :) I realize, as always, you want to be sure your doctor is well versed in proceedure. I know some guys here have done it...so how was it overall? Personally, I'm leaning towards SBRT..30 or so holes in your perineum seems kind of ...let's say "icky" not to mention sometimes leaving them in overnight...YIKES
Posted 9/17/2015 3:01 PM (GMT 0)
Well, for the record it's 17 holes. At least at UCLA it was. Also, I think many--if not most--programs handle the fractions in a way that you don't have an overnight anymore. (I did and it wasn't particularly comfortable, although compared to the other indignities of having PC not that bad in the grand scheme of things.)

My general understanding is that HDR brachy and SBRT are similar from a radiation perspective. I think they're both good choices for most patients.
Posted 9/17/2015 3:05 PM (GMT 0)
17...ok, I was thinking of saturation biopsy probably. That's a little better :)
Posted 9/17/2015 4:49 PM (GMT 0)
sheepguy-
You may want to put the term "HDR brachytherapy" in the search bar. A lot of guys have had it and generally write glowingly about it. The problem is usually finding local ROs who do the monotherapy, so some guys travel to Detroit or LA or other places for it.
Posted 9/17/2015 6:56 PM (GMT 0)
I had HDR brachytherapy nearly five years ago. It wasn't bad at all. My arthroscopic knee surgery was far worse. I had two procedures a week apart and did not require overnight stay or catheterization.

Certainly worth looking into, but as Tall Allen says, the experienced practitioners are not plentiful. In my case I had two excellent choices in Atlanta. Permanent seed brachytherapy is much more widely available.

Where are you located?
Posted 9/17/2015 7:30 PM (GMT 0)
I had HDR mono therapy last year - 4 sessions - 17 'holes' each time over a 6 week period.

To be honest, it really wasn't that bad and much less stressful than other procedures that I have endured. I was pretty much back to normal activities within a couple of days each time. Urinary urgency went away after a couple of months.

Now I am having urine retention problems that may or may not be related to radiation damage. Nothing was found during a cystoscopy but my Uro wants to deal with this more aggressively if nothing changes (meds now) in another month or so. Also, my Uro doesn't think that my PSA #'s have been dropping fast enough and will be following up more diligently for a while.

Would I do the HDR mono again? Assuming that my retention problem is not due to radiation damage then absolutely!

Complicating this is my totally unrelated hiatal hernia...was hoping for a break for at least a year but doesn't seem to be my luck so far.

Anyway, you can see the details in my signature.
Posted 9/18/2015 2:13 PM (GMT 0)
Some more reading for you on HDR monotherapy from another PCa forum:

https://www.inspire.com/groups/us-too-prostate-cancer/discussion/experience-with-one-fraction-hdr/

https://www.inspire.com/groups/us-too-prostate-cancer/discussion/side-effects-hdr-monotherapy-seems-to-have-the-least/

I was trying to decide between IGMRT and SBRT when I learned about HDR monotherapy, which is the direction I'm leaning now. Lots to consider, that's for sure, including insurance coverage. FYI, there is a clinical trial at NIH/NCI in Bethesda, MD on one fraction HDR which just started recruiting (https://clinicaltrials.gov/ct2/show/study/NCT00924027?term=%22hdr%22+%22prostate%22&state1=NA%3AUS%3AMD&rank=1#contacts).
Posted 9/18/2015 2:36 PM (GMT 0)
One of the best websites is www.cetmc.com. This is by Dr. Jeffrey Demanes, the father of HDR Brachytherapy and head of the department at UCLA Medical Center. He has a section devoted to mono-therapy and he publishes the longest period of results of the HDR practitioners.
Posted 9/18/2015 3:12 PM (GMT 0)
I had it nine months ago in Atlanta. Two treatments, two weeks apart.

You're asleep so you won't know they've put the 15 catheters in your perineum. The worse part of it, to me, was the catheter in my penis. That was a first for me and I felt like I needed to pee the whole time I was awake. I even told them I was about to stand up and pee with all those things in me.

You can read my story about the actual procedure. Five minutes of the first session was how I envision hell. When he yanked those catheters out of my perineum it was the most pain I've experienced in a while. But, it was over in about two minutes. And then, when the nurse yanked the catheter out of my Johnson, it was fairly painful as well.

However, I felt very good about three hours later (after a two hour nap).

My second session was quite different. They did the same things, but I didn't feel pain hardly at all. I braced for the yanking, but it wasn't a big deal. I did tell them prior of my first experience so I figure the anesthesiologist did something different that second round.

It's weird because I remember different parts about each treatment session. That's good stuff they give you so to me it was better than a scoping I had to my elbow a couple years ago.

Otherwise, I'm happy with my treatment and the only side effect that remains after nine months is my sperm volume is pretty low.

After the second procedure, I was back working out and playing basketball in about two weeks. I was at work the next day, after both sessions.

I got my 9-month checkup yesterday so I'm waiting on my PSA results. I'll post later.
Posted 9/18/2015 11:33 PM (GMT 0)
I have tried to Google exactly which centers in the U.S. do HDR combo brachy but haven't been to find a definitive list. Does such a list exist? My husband is a G9 so if we decide to go this route it would need to be with ADT and radiation as well. Most likely, it is not performed here in Iowa and the logistics of our life will not lend easily to pursuing this method of treatment.
Posted 9/18/2015 11:38 PM (GMT 0)
peanut...I'm not aware of a list, but I'd bet that if you opened up a thread specifically asking about combo therapy you would get some suggestions. As a G9, I can tell you I had HDR brachy, IMRT and HT all at UCLA. (And I'm doing very well, so far.) I know that's a haul from Iowa, but I know a few on this board have travelled there from Hawaii.

If you did travel, would you do the IMRT locally? That's typically five weeks with combo treatment so that would be a long time to travel...
Posted 9/19/2015 1:07 AM (GMT 0)
It's not particularly pleasant and also not terribly painful. To me, it's what you do IF you decide it's the best procedure for you for efficacy and for risk of side effects. If it is, then you endure it, as have plenty of others. That's how I approached it.

Post Edited (Works Out) : 9/18/2015 8:33:01 PM (GMT-6)

Posted 9/19/2015 1:34 AM (GMT 0)
have you considered LDR? BT was much simpler and of course quicker than IGRT.

ed
Posted 9/19/2015 12:42 PM (GMT 0)
I'd start looking here. They have filters to find a center.

IA/www.facs.org/search/cancer-programs?state=IA
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