High Dose Rate Brachytherapy

I was treated in early 2013 for PC. At the time I was advised of all the risks including the risk of the radiation causing a second cancer. I didn't think too much of it at the time. I should have paid more attention. I have been diagnosed with Myelodysplastic Syndromes (MDS) and have had several bone marrow biopsies. Each one shows more cytogenetic abnormalities. The latest one is monosomy 7 which is particularly bad in MDS. My hematologist / oncologist stated my MDS was likely caused by the radiation.

Just food for thought for those of you who are considering this therapy.

DataDavid

DataDavid,

Very sorry to hear about your diagnosis. My brother had MDS and sadly passed away just a few weeks ago from complications related to that. For the record, he did have radiation to treat prostate cancer--IMRT in his case. He also had chemotherapy for something unrelated to prostate cancer and I realize that's another possible link.

As I understand it, the risk of secondary cancers from radiation is very, very low, although that probably doesn't matter if you happen to be the person it happened to. At the same time, how did your oncologist attribute yours to your brachytherapy? As I understand MDS, 90% of cases have no known cause.

I wish you all the best as you go through this. Good luck to you and sending good thoughts your way.

My brother also had damage to monosomy 7, as well as two other chromosomes. Interesting correlation between his case and yours.

Again, all my best to you as go through this.

Hate that for you David, and Micheal.

Is there any sort of genetic test or similar that might indicate which persons are more predisposed to acquire MDS through radiation therapy?

Ken, I am also unaware of a genetic test, but I am interested in digging into this a bit deeper since my brother's case and DataDavid's sure have some similarities (at least on the surface). (Note to Data: but I'm still counting on you to do than better my brother did. He had some rather singular complications during treatment.)

The idea of "secondary" cancers comes up here on occasion for guys that are considering radiation. I was always under the impression that they were things like rectal and bladder cancer that could also be considered collateral damage since they were in the general area of the PC radiation. I had never considered it beyond that before.

I was always under the impression that secondary cancers from radiation were very low--somewhere around 1% and maybe even less. But I don't know specifically--hopefully someone can weigh in here. If you're referring to MDS specifically as an outcome, then one would think the number would be even lower, although again I'm speculating.

Here is a link to a document from the American Cancer Society that references "second cancers" and MDS (see page 2.

http://www.cancer.org/acs/groups/cid/documents/webcontent/002043-pdf.pdf

The majority of my research has been done on the web using Google plus I have purchased two books - one on blood disorders in general and one specifically on MDS. If you are going to use the web, look for sites that are education (.edu), organizations (.org), government (.mil), etc. I have found some information at commercial sites (.com) but I am always skeptical wondering what is their interest. I try and find collaborative information on information I get from commercial sites.

MDS caused by a prior therapy is referred to as therapy related MDS, t-MDS, or secondary MDS. From what I have ready it has a worse prognosis.

And by the way the only curative therapy for MDS is a stem cell transplant (SCT) (sometimes referred to as a bone marrow transplant. When they are evaluating you for a SCT one of the things that increase your risk is having had a prior solid tumor, e.g., prostate cancer.

Here is a quote from the AAMDS.org site:
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Secondary or t-MDS

It is important to recognize that, while secondary MDS (t-MDS) represents approximately 10% of MDS cases, the chance of developing MDS if you are treated for another cancer is very low - less than 1/2 of 1% (0.5%) in most cases, though the risk increases in patients who receive multiple rounds of chemotherapy and radiation therapy, and also in those who undergo stem cell transplants for conditions like lymphoma.
_______________________________

The news just gets better and better.


Cheers


Data

Post Edited (DataDavid) : 11/16/2015 12:46:13 PM (GMT-7)

Really interesting thread, thanks David and others for responding and following thru.

David, I got to thinking about this and wondered which HDR protocol was followed with your HDR brachy?

I know you can only guess and that anything related to this may well be a stab in the dark, but do you think a different protocol, or different treatment may have done differently or just that you were just an unlucky one of the few?

Once you informed the Radiation Oncologist that did your HDR, did they mention if they saw any reason to change the protocol?

I really do hate it for you, and in all honesty I'm not sure I would be handling it as well as you seem to be doing.

Thanks for your prompt response.

Got to be a tough spot for you to be in. Thank you for sharing.

Agent Orange seems to be the gift that keeps on giving.

Feel for you and everyone else that went over. I was very fortunate to have spent my two draftee years stateside.

My hope is that your final choice on this issue will be the best one for you.

Warm regards

Ken