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My first post - PCa diagnosed - looking for advice on HDR BT

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Posted 2/3/2016 2:38 AM (GMT 0)

Dewayne said...
My first procedure was different in that it hurt like a you-know-what when they pulled the catheters out. It only lasted for a couple of minutes but it was a 10! The second one was no pain. I think it might have had something to do with the anesthesia methods. I let them know though. And there was hardly any pain the second session.

Short term issues: It hurt to pee for a couple of days. The urgency to pee lasted a couple of months. Blood in semen the first time, and then it was brown for the next couple of times. And then, nothing (no liquid) for a couple of months. Once off the Flomax, the liquid came back but it's never the same. There was a couple months of pain after ejaculation, from like months 4 - 6. Sex is still great but there's a different feeling at the end because of that.

Thanks, this is valuable information.

Sorry I've been absent for a while guys, work has been crazy since the end of last year. I've also been reflecting quite a bit.

I'm scheduled for HDR BT monotherapy at FCCC, two sessions, 1st on Feb 17, followed by the 2nd a week later on Feb 24. I'm a wuss when it comes to pain and I addressed this with the urologist that will be handling my case at FCCC and was told I would be under general anesthesia for the entire procedure and would wake up in the recovery area, so I dearly hope I will avoid any level "10" pain associated with the needle catheters. shocked smhair

I do have a family history of UTI in males on my mother's side of the family and this is also of concern for me as the BT process could exacerbate this issue. I've only had a few UTI's over the past 20 years, so it's not a frequent issue, but I am left wondering what the short and long term impact may be.

I'm supposed to start Flomax one week before Feb 17 to help with the short term urinary side effects.

Question, I currently commute via regional rail about an hour each direction to/from work - minimum, during which I will not have access to any restrooms. My current plan is to at home the day after each procedure (Thursday), and to work from home the following day (Friday), then back in the office the following Monday. I've read all about the urinary urgency side effects - just how bad is it really?

T-minus two weeks as of tomorrow! :-)
Posted 2/3/2016 2:43 AM (GMT 0)

Paul65 said...
Thanks HitchHiker! My Fusion biopsy is Tuesday AM, so if you happen to be online before that and have any insights, 'top-tips' or things you wish you had known/done... let me know, forewarned is forearmed and all that!

yeah

Paul, sorry to have missed this post. How did your fusion biopsy go at JH? I will search for more recent posts from you now. Hope it went as well as can be expected! :-)
Posted 2/3/2016 4:39 AM (GMT 0)

Somebody said...
... was told I would be under general anesthesia for the entire procedure and would wake up in the recovery area

Hitchhiker, you might want to double check on this. For my procedure (as well as all others that I have heard about), I was under general anesthesia only for the insertion of the tubes. During the radiation and for tube removal, I was awake. Since I had 3 radiation fractions each session, I was in the hospital bed with the tubes inserted (and not under general) for about 24 hours each session. If you are going to have multiple fractions, I don't think they would keep you under general anesthesia the whole time.

If you are going to be awake for some of the time, check to see if you will have a push button for dosing yourself with morphine (or the synthetic equivalent). If so, you will want to have a watch accessible. The push button has a timer, so it will only dose you every 5 minutes or so. I was maxing out on the push button each time they re-positioned the tubes before each fraction. Also, as previously stated, it hurts when they pull the tubes, but only for a few seconds. I maxed out the dosage for that as well.
Posted 2/4/2016 2:56 AM (GMT 0)

Hawaii-Guy said...

Somebody said...
... was told I would be under general anesthesia for the entire procedure and would wake up in the recovery area

Hitchhiker, you might want to double check on this. For my procedure (as well as all others that I have heard about), I was under general anesthesia only for the insertion of the tubes. During the radiation and for tube removal, I was awake. Since I had 3 radiation fractions each session, I was in the hospital bed with the tubes inserted (and not under general) for about 24 hours each session. If you are going to have multiple fractions, I don't think they would keep you under general anesthesia the whole time.

If you are going to be awake for some of the time, check to see if you will have a push button for dosing yourself with morphine (or the synthetic equivalent). If so, you will want to have a watch accessible. The push button has a timer, so it will only dose you every 5 minutes or so. I was maxing out on the push button each time they re-positioned the tubes before each fraction. Also, as previously stated, it hurts when they pull the tubes, but only for a few seconds. I maxed out the dosage for that as well.

HG,

Thanks for the info, I will give the RN for my RO a call tomorrow to get clarity. IIRC, the urologist that will be performing the cystoscopy during my procedure said total time I would be under anesthesia would be about three hours. The way FCCC is set up, I never leave the treatment room, one stop shopping. I took that to mean I'd be out for those three hours, during which I will receive two fractions of HDR radiation.

I had read the HDR BT procedural description that is out on the UCLA site which had verbiage about having the catheters in while awake and having a push button dosing option. I specifically expressed concern about this approach during my meeting with my urologist, and came away thinking this wasn't the case at FCCC, but I will get clear verification tomorrow and post back once I know for sure. Again, I'm somewhat of a wuss when it comes to pain. scool
Posted 2/4/2016 2:58 PM (GMT 0)
At UCLA you're under anesthesia when they insert the catheters and they do a spinal block to numb you from the waist down. (Which is a very odd feeling. Or lack of feeling.) I'm not sure how long you're under, but I didn't think it took anywhere near three hours to insert the catheters.

FYI, I had the pain dosing machine and totally overused it for my first time. I have spinal stenosis (which was undiagnosed at the time) and was in big back pain from having to be mainly motionless the whole time so I was acting like I was playing a pinball machine with the trigger. Totally over-drugged myself and it made the next 2-3 days of recovery rough. Second time around we supported my back better, I was fine with my back and I didn't even use the pain pump. Felt pretty good right away afterwards.

Every once in a while there was some pain when they adjusted the catheters, but it was brief. It did hurt a fair amount when they removed them. But overall, I didn't consider it a painful procedure.
Posted 2/8/2016 4:58 PM (GMT 0)
Just sharing my fusion biopsy results for reference from 5/15:

DIAGNOSIS:

1. Prostate, right lobe, base lateral, biopsy: Benign prostatic

tissue.

2. Prostate, right lobe, base medial, biopsy: Benign prostatic

tissue.

3. Prostate, right lobe, mid lateral, biopsy: Benign prostatic

tissue.

4. Prostate, right lobe, mid medial, biopsy: Benign prostatic

tissue.

5. Prostate, right lobe, apex lateral, biopsy: Small focus of

adenocarcinoma, Gleason score 6 (3+3) with perineural invasion.

6. Prostate, right lobe, apex medial, biopsy: Adenocarcinoma,

Gleason score 6 (3+3) involving 65% of 1 core.

7. Prostate, left lobe, base lateral, biopsy: Fibromuscular tissue.

8. Prostate, left lobe, base medial, biopsy: Benign prostatic

tissue.

9. Prostate, left lobe, mid lateral, biopsy: Benign prostatic

tissue.

10. Prostate, left lobe, mid medial, biopsy: Benign prostatic

tissue.

11. Prostate, left lobe, apex lateral, biopsy: Benign prostatic

tissue.

12. Prostate, left lobe, apex medial, biopsy: Benign prostatic

tissue.

13. Prostate, right lobe, MR right distal apical PZ axial, biopsy:

Adenocarcinoma, Gleason score 6 (3+3) involving 45% of 1 core.

14. Prostate, right lobe, MR distal apical PZ sagittal, biopsy:

Adenocarcinoma, Gleason score 6 (3+3) involving 75% of 1 core.

15. Prostate, right lobe, MR right apical TZ axial, biopsy:

Adenocarcinoma, Gleason score 6 (3+3) involving 10% of 1 core.

16. Prostate, right lobe, MR right apical TZ sagittal, biopsy:

Adenocarcinoma, Gleason score 6 (3+3) involving 30% of 1 core.

17. Prostate, left lobe, left apical mid PZ axial, biopsy: Benign

prostatic tissue.

18. Prostate, left lobe, left apical mid PZ sagittal, biopsy:

Benign prostatic tissue.

Immunoperoxidase and in-situ hybridization tests performed here and

used for diagnosis were developed and their performance characteristics

determined by the Laboratory of Pathology, NCI. They have not been

cleared or approved by the U.S. Food and Drug Administration. The FDA

has also determined that such clearance or approval is not necessary.

This laboratory is certified under the Clinical Laboratory Improvement

Amendments of 1988 (CLIA) as qualified to perform high complexity

clinical laboratory testing.

CLINICAL INFORMATION: Brief Clinical History: Prostate cancer

PROCEDURE: Operative Findings: See operative note Post-Operative

Diagnosis:

Prostate cancer Pre-Operative Diagnosis: Prostate cancer

SPECIMENS SUBMITTED:

1. PROSTATE NEEDLE BIOPSY, RIGHT LOBE, base lateral

2. PROSTATE NEEDLE BIOPSY, RIGHT LOBE, base medial

3. PROSTATE NEEDLE BIOPSY, RIGHT LOBE, mid lateral

4. PROSTATE NEEDLE BIOPSY, RIGHT LOBE, mid medial

5. PROSTATE NEEDLE BIOPSY, RIGHT LOBE, apex lateral

6. PROSTATE NEEDLE BIOPSY, RIGHT LOBE, apex medial

7. PROSTATE NEEDLE BIOPSY, LEFT LOBE, base lateral

8. PROSTATE NEEDLE BIOPSY, LEFT LOBE, base medial

9. PROSTATE NEEDLE BIOPSY, LEFT LOBE, mid lateral

10. PROSTATE NEEDLE BIOPSY, LEFT LOBE, mid medial

11. PROSTATE NEEDLE BIOPSY, LEFT LOBE, apex lateral

12. PROSTATE NEEDLE BIOPSY, LEFT LOBE, apex medial

13. PROSTATE NEEDLE BIOPSY, RIGHT LOBE, MR right distal apical PZ axial

14. PROSTATE NEEDLE BIOPSY, RIGHT LOBE, MR right distal apical PZ

sagittal

15. PROSTATE NEEDLE BIOPSY, RIGHT LOBE, MR right apical TZ axial

16. PROSTATE NEEDLE BIOPSY, RIGHT LOBE, MR right apical TZ sagittal

17. PROSTATE NEEDLE BIOPSY, LEFT LOBE, Left apical-mid PZ axial

18. PROSTATE NEEDLE BIOPSY, LEFT LOBE, Left apical-mid PZ sagittal
Posted 2/8/2016 5:11 PM (GMT 0)
Results from previous biopsy at JH 11/13:

INTERPRETATION AND DIAGNOSIS: (amd) 11/12/2013 @ 06:28 pm

1) PROSTATE, RIGHT APEX (BIOPSY): PROSTATIC ADENOCARCINOMA, GLEASON
SCORE 3 + 3 = 6 INVOLVING 5% OF ONE (1) OF TWO (2) CORES. PERINEURAL
INVASION IDENTIFIED. MARKED CHRONIC INFLAMMATION. SEE NOTE.

DR. JONATHAN EPSTEIN HAS REVIEWED THIS PART AND CONCURS.

2) PROSTATE, RIGHT MID (BIOPSY): BENIGN PROSTATIC TISSUE WITH
CHRONIC INFLAMMATION AND FOCAL ACUTE INFLAMMATION.

3) PROSTATE, RIGHT BASE (BIOPSY): BENIGN PROSTATIC TISSUE WITH
CHRONIC INFLAMMATION.

4) PROSTATE, LEFT APEX (BIOPSY): BENIGN PROSTATIC TISSUE WITH FOCAL
CHRONIC INFLAMMATION AND FOCAL ACUTE INFLAMMATION.

5) PROSTATE, LEFT MID (BIOPSY): BENIGN PROSTATIC TISSUE.

6) PROSTATE, LEFT BASE (BIOPSY): BENIGN PROSTATIC TISSUE WITH
CHRONIC INFLAMMATION.
Posted 2/9/2016 8:49 PM (GMT 0)

Hawaii-Guy said...

Somebody said...
... was told I would be under general anesthesia for the entire procedure and would wake up in the recovery area

Hitchhiker, you might want to double check on this. For my procedure (as well as all others that I have heard about), I was under general anesthesia only for the insertion of the tubes. During the radiation and for tube removal, I was awake. Since I had 3 radiation fractions each session, I was in the hospital bed with the tubes inserted (and not under general) for about 24 hours each session. If you are going to have multiple fractions, I don't think they would keep you under general anesthesia the whole time.

If you are going to be awake for some of the time, check to see if you will have a push button for dosing yourself with morphine (or the synthetic equivalent). If so, you will want to have a watch accessible. The push button has a timer, so it will only dose you every 5 minutes or so. I was maxing out on the push button each time they re-positioned the tubes before each fraction. Also, as previously stated, it hurts when they pull the tubes, but only for a few seconds. I maxed out the dosage for that as well.

OK, finally was able to connect up with FCCC this afternoon. Playing phone tag is killer - I tried using the online portal to ask my questions and they always call me instead.

So, FCCC I'm out for the entire procedure, because they only give two fractions, spread out over two days a week apart. 1350 CGy or 13.5 Gy per fraction, all at one time, for a total of 2700 CGy or 27Gy total. This is their protocol at FCCC. I asked if they adjusted the total radiation dosage based upon grade of cancer, and the doctor indicated no, but I was only talking to a resident and not Dr. Horwitz. Does this sound right? The total Gy seems a bit light, but I'll go back and run the calcs based upon with TA said under separate cover using alpha/beta hypofractionated ratios.
Posted 2/9/2016 9:20 PM (GMT 0)
OK, so I found the equation from TA via search:

Equivalent dose=n*d*(d+a/b)/(2+a/b)

where n=number of fractions
d=dose per fraction
a/b= alpha/beta ratio

Using TA's original numbers for his SBRT treatment to validate my numbers:

5*8*(8+1.5)/2+1.5) =
5*8*(9.5/3.5) =
5*8*2.71 = 108.57 Gy

Using my numbers as proposed from FCCC:

2*13.5*(13.5+1.5)/(2+1.5) =
2*13.5*(15/3.5) =
2*13.5*4.29 = 115.71Gy

I'm not sure if this equation really "works" for HDB-mono but those are the numbers. I've seen other HDB mono that delivers at least what appeared to be higher Gy, like in the mid-high 30's range.

Using the BED equation:

BED = nd(1+d/1.5)

BED = biologically effective dose, n = number of fractions, and d = dose per fraction.

BED = 2*13.5(1+13.5/1.5) = 261Gy if my numbers are right.

TA, any thoughts? I just want to be doubly sure that what I'm choosing to do at FCCC is the right thing to do.

Post Edited (HitchHiker) : 2/11/2016 1:37:00 PM (GMT-7)

Posted 2/9/2016 9:47 PM (GMT 0)

HitchHiker said...
So, FCCC I'm out for the entire procedure, because they only give two fractions, spread out over two days a week apart.

I'm not sure I understand this. I presume by "entire procedure" they mean you'll be out for the implant, not the radiation dosing, right?
Posted 2/9/2016 10:24 PM (GMT 0)

Michael_T said...

HitchHiker said...
So, FCCC I'm out for the entire procedure, because they only give two fractions, spread out over two days a week apart.

I'm not sure I understand this. I presume by "entire procedure" they mean you'll be out for the implant, not the radiation dosing, right?

Michael, sorry for not being more clear. I'm under anesthesia for the entire process from start to finish at FCCC. I will wake up in the recovery room after the needles and implant are removed of course, and am put under before this implant process starts. This is because they aren't delivering multiple fractions each day I'm there, I get a single fraction of 1350CGy at one time, so there's no need to undergo an epidural to be awake for multiple fractions. The entire procedure will only take 2-3 hours at most from the time I wheel into the treatment room until I'm wheeled out. I then go back a week later for the exact same procedure. I hope this makes sense. scool

I think the reason UCLA uses the epidural is because of one of two reasons. One, they deliver multiple fractions of HDB each day, which extends the amount of time necessary per day for the patient. Two, they don't have all of the equipment in a single treatment room that is necessary to deliver HDB and they have to move the patient between rooms for scans vs. actual radiation treatment. FCCC has all of the required equipment in a single treatment room, so the patient is stationary from start to finish for each fractional HDB treatment.
Posted 2/9/2016 10:47 PM (GMT 0)
Hey Hitchhiker what are you going to do if "TA" doesn't agree with the dosage? Suggest one to the RO?
Posted 2/10/2016 12:19 AM (GMT 0)
Interesting info Hitchhiker. FCCC is definitely speedier than UCLA if they can do the implant, one fraction and then remove the implant in 2-3 hours. After the implant, I probably didn't get the the first fraction for several hours. Maybe the difference is UCLA wasn't in a hurry to deliver the first radiation dose since I would be staying overnight anyway.

I remember after the implant they told me they would be calculating the radiation dose and I thought maybe they were using an abacus based on how long it took.
Posted 2/10/2016 6:02 PM (GMT 0)

sheepguy said...
Hey Hitchhiker what are you going to do if "TA" doesn't agree with the dosage? Suggest one to the RO?

SG,

None of us here are doctors of course. That said, since I'm young, I'm more concerned about the longer term cure rates, and overall, whether for hyper or hypo fractionation approaches, higher doses at least seem to offer better long term cure rates. I did some additional homework last night and there are a number of different HDB-mono fractional total Gy amounts, from as low as 21Gy to as high as 45Gy, using anywhere from two to six fractions, though most seem to fall in the middle somewhere (mid 30's seems average). Any data or opinions from anyone are most appreciated.
Posted 2/10/2016 6:16 PM (GMT 0)

Michael_T said...
Interesting info Hitchhiker. FCCC is definitely speedier than UCLA if they can do the implant, one fraction and then remove the implant in 2-3 hours. After the implant, I probably didn't get the the first fraction for several hours. Maybe the difference is UCLA wasn't in a hurry to deliver the first radiation dose since I would be staying overnight anyway.

I remember after the implant they told me they would be calculating the radiation dose and I thought maybe they were using an abacus based on how long it took.

Michael, yes, they seem to have it down to a science at FCCC such that the process is now outpatient. Provided I can void my bladder without a catheter on the day of treatment, I am homebound the same day.

Were you only overnight one night, or multiple nights? Your having an epidural makes complete sense to me now based upon what you wrote. :-)
Posted 2/18/2016 9:45 PM (GMT 0)
Well, one HDR treatment down, one to go! cool

I had my first fraction of HDB at FCCC yesterday bright and early. Had to be there at 6:00 AM, spent Tuesday on the usual prep stuff.

I was all signed in and had all the requisite meetings with the various doctors and such by about 8:00 AM. I'd say I was "wheels up" into the OR by 8:30 AM and I awoke in the recovery area around 12:00 noon. I was able to avoid my bladder around 1:00 (ouch, that hurt LOL), and was checked out and headed back home by 1:30 PM.

I was a bit groggy from the anesthesia immediately after I woke up but the most uncomfortable part was the removal of the catheter. Getting the catheter removed was about two seconds of burning discomfort but outside of that the whole procedure really wasn't as bad as I was expecting. I mean after all of the reading about 15-25 needles through a rather sensitive area, I think I overestimated the discomfort from the actual procedure itself.

The acute initial side effects on day one of recovery so far are limited to peeing razor blades. Having a history of UTIs, the peeing thing feels like a bad version of a UTI. I've read that the catheter has this effect in the short term for the first day or so. We'll see what happens heading into the weekend. Any advice on the urinary discomfort is appreciated of course. I'm taking Tylenol with Codeine for any pain and Motrin to help with inflammation, and of course flowmax. I think I underestimated the acute short term urinary side effects.

I haven't really had a BM yet so can't say anything in that area just yet.

In some weird way I'm actually looking forward to getting past round two next week and getting on with my life - in whatever form that takes with regard to side effects. I'm hopeful that several months from now I'm well on my way back to something akin to normal or at least a "new normal" that is not too far away from the life I've been living prior - just with more of a focus on better overall health. Thanks for reading! cool
Posted 2/18/2016 9:55 PM (GMT 0)
Congrats on getting the first one under your belt! With the burning urination, I found that taking urispas helped somewhat, as did some warm baths. It didn't last more than a few days in my case--you'll probably be feeling great just when it's time to go back and do it all over again!

FWIW, I also found sitting on hard surfaces difficult at first. Also goes away pretty quickly...

And yes, FCCC sure gets you in and out quickly!
Posted 2/18/2016 9:57 PM (GMT 0)

Michael_T said...
Interesting info Hitchhiker. FCCC is definitely speedier than UCLA if they can do the implant, one fraction and then remove the implant in 2-3 hours. After the implant, I probably didn't get the the first fraction for several hours. Maybe the difference is UCLA wasn't in a hurry to deliver the first radiation dose since I would be staying overnight anyway.

I remember after the implant they told me they would be calculating the radiation dose and I thought maybe they were using an abacus based on how long it took.

Michael, now that I'm post day one of HDB at FCCC, having been through it, I was rolled into the OR, moved over to the operating table, and they started the IV, next thing I remember, I woke up in the recovery room. No memory at all of the entire procedure.

I spoke to Dr. Horwitz prior to my procedure and mentioned that some men spoke of epidurals and multiple fractions and such, and his assessment was that this was more common in the past when a single implant was done and multiple fractions were done via a single implant - usually 3-4 fractions - over 1-2 days, especially in the 90's and early 2000's. This was common especially in Seattle and UCLA - but most HDR is now via 1-2 implants - and dosimetry and planning via the physicists is done intraoperatively - usually 2-4 hours total. There's a randomized trial in Canada currently - IIRC - that is comparing data between a single and a dual implant approach.

So, one down, one to go for me. Half way there! :-)

Post Edited (HitchHiker) : 2/18/2016 4:21:17 PM (GMT-7)

Posted 2/18/2016 10:05 PM (GMT 0)

Michael_T said...
Congrats on getting the first one under your belt! With the burning urination, I found that taking urispas helped somewhat, as did some warm baths. It didn't last more than a few days in my case--you'll probably be feeling great just when it's time to go back and do it all over again!

FWIW, I also found sitting on hard surfaces difficult at first. Also goes away pretty quickly...

And yes, FCCC sure gets you in and out quickly!

Michael, thanks so much for the quick response! I'll take a look into urispas right now, and add warm baths to my daily routine! :-)

Yep, I figure I'll just start feeling somewhat akin to normal and then it will be time to do it all over again next week, but I'm the type that is most anxious when I don't have any point of reference in life, so now that I've been through it - I'm ok with round two because I know what is coming and how to best prepare for it. :-)
Posted 2/18/2016 10:37 PM (GMT 0)
Thanks for posting updates, please continue doing so.

Very interesting to see your actual experience, and glad to see that someone in that area is doing a good bit of HDR Brachy monotherapy.

You seem to have certainly done a lot of homework.

I am still not a bonafide member of the club here, but as I was doing my due diligence I decided for various reasoning - quite similar to your reasoning that if I elected for treatment that HDR mono would likely be the way to go.

While there are definitely members of the forum who have had it, they seem somewhat fewer in number overall so it is quite interesting to read more in detail about your experience as the event transpires.

Glad you are doing so well, and hope you continue to do so and post followups.
Posted 2/18/2016 11:03 PM (GMT 0)
Thanks for posting HitchHiker. So far so good. Here's hoping you are well on your way to a successful outcome.
Posted 2/19/2016 7:53 PM (GMT 0)
Ken, thanks for posting. This is sort of becoming my diary, so I will keep posting my experiences day to day.

The good news is the peeing razor blades issue seems to have subsided as of late yesterday. Still don't have the urine stream I'm used to, still have slight burning, but nowhere near what it was. Still haven't had a BM yet, so I'll report back once I cross that bridge. :-) I've had some mild gas and it hasn't been too painful so hopefully that's a good sign.

Took a nice long shower and felt around "down there" while cleaning - it seems like most of the needles were closer to the anal area - at least it seems more sensitive closer to that area right now. I figured most of the needles would be midway between the scrotum and the anus but at least based upon the sensitive areas they seem closer to the anus. Not sure what this might mean when it comes to BM time, only time will tell.

Today overall I think I feel better, but I also sense some additional inflammation/tension. I'm sure this is normal as well - from everything I've read. It doesn't hurt per se, but the presence is there. I do have hemmorrhoids, so that could be playing into this as well.

It's probably also worth mentioning that I had a nocturnal erection overnight. I remember waking up. Felt kinda weird all things considered - a bit uncomfortable to be sure - but was thankful to feel anything given the trauma I just experienced on Wednesday via the first HDR implant. Still taking ibuprofen and Tylenol with codeine though I'm starting to cut back today on the pain meds - I'll cut the dosage in half today and see how things go heading into tomorrow. As always, thanks for reading and for your encouragement! cool
Posted 2/19/2016 8:18 PM (GMT 0)

Ken said...
Thanks for posting updates, please continue doing so.

Very interesting to see your actual experience, and glad to see that someone in that area is doing a good bit of HDR Brachy monotherapy.

You seem to have certainly done a lot of homework.

I am still not a bonafide member of the club here, but as I was doing my due diligence I decided for various reasoning - quite similar to your reasoning that if I elected for treatment that HDR mono would likely be the way to go.

While there are definitely members of the forum who have had it, they seem somewhat fewer in number overall so it is quite interesting to read more in detail about your experience as the event transpires.

Glad you are doing so well, and hope you continue to do so and post followups.

Ken, agreed. I came here primarily because of the large community of PCa experiences. I was very glad to find so many other guys here willing to share their experiences in such detail. I plan to pay it forward as well, to the best of my ability.

I did a lot of homework over the years. I was really hoping to be able to hold out long enough for some kind of newer clinical trial that treats PCa at the cellular layer, like PSMA based treatments or some other more focused/targeted treatments, but most of the clinical trials are in the very early stages and are more focused on those with advanced prostate cancer as opposed to early stage organ confined prostate cancer.

I was a big proponent of proton therapy and it's theoretical advantages in minimizing side effects, and I think the newer pencil beam proton therapies that are more akin to IMRT or IGRT show more promise, but in the end I decided to go with something that's bit more proven and more targeted at least in theory - HDR BT - also a bit more invasive obviously.

So far, so good. I'm hopeful the side effects aren't too bad and I can get on with my life after next week and focus on healing.
Posted 2/20/2016 10:57 PM (GMT 0)
So far today is fairly uneventful. I stopped taking ibuprofen as planned and definitely feel a difference without the NSAIDS in play, more discomfort than pain per se. I've also been venturing out more, running errands and so forth, getting more active. Still taking one Tylenol with Codeine pill every six hours or so just to mimimize any pain.

Still no BM yet either. Had my first procedure on Wednesday of this week. Did some searching on this forum and it seems like most folks average 3-5 days before BMs resume. I have been passing gas which from what I've read is a good sign that my GI system is working. My wife is a nurse and says if we get past the weekend we should follow up with FCCC just to ensure they don't want me to do anything special prior to next Wednesday's second implant procedure. I started taking a stool softener just to help the process, as of last night (docusate sodium), we'll see if that helps some. cool
Posted 2/20/2016 11:24 PM (GMT 0)

Michael_T said...
FWIW, I also found sitting on hard surfaces difficult at first. Also goes away pretty quickly...

Definitely found this to be the case today. Ventured out to one of our usual eating spots - a hole in the wall diner we frequent - it has all hard seating. I didn't really give it much thought til we got there - after which I remembered you posting about this issue.

Suffice it to say after about 45 minutes I was ready to depart the establishment. smilewinkgrin
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