Met With Radiation Oncologist - Not convinced

Hi all,

Completed my second step of my three step decision making process. Met with my Uro who is surgeon for open RP last week.

Met with RO today and waiting for appointment with robot surgeon.

He kept talking about HDR and external beam. My interest was in LDR. I did get the answers to all of my questions and then asked how many procedures he has performed. He said he would have to refer me to a colleague as that was a specialized procedure (LDR) because in Ontario it is only available to intermediate cancer patients (G7 low volume is now allowed, was G6 only) with PSA under 10 and no nodules on DRE. I thought this guy was the one that would perform the procedure. Apparently the specialist is on vacation and this RO was seeing his referrals.

As to side effects there is a possibility of ED within 3-5 years. Incontinence is rare however urgency is common.

There is a clinical trial available that has 2 HDR sessions without external beam however there is not a lot of data on long term outcomes.

This I did learn?

Apparently in Ontario if I have LDR I can not be cremated when I die. I tried to find that on the internet and can only find an article suggesting cremation would be allowed two years after implant.

I would not be able to hold my grandson for three months (he turns 1 in May). It would be ok to be in the same room but not close to him.

We also have a small dog who is like a child to us and he said that the dog would get radiation effects but not likely would impact her health as she would not live long enough to get cancer from the radiation. This is a lap dog and tied to my hip every waking moment.

My instincts are saying Davinci 1st choice, open RP second and LDR last. Still need to have the meeting with the robot surgeon to see if I qualify. I have had previous abdominal surgery.

Newtpoc: LDR is a tried and true BT treatment with survival rates as good as and sometimes better than other treatments. It has been around much longer than HDR or SBRT with up to 15-year survival reports available. No other treatment is in and out of the Hospital the same day with no procedures necessary.

You are you own best advocate and will make a decision that will affect the rest of your life. This brings us to SEs which is another big plus in favor of LDR. Look through the LDR patients on this forum and you will see only very recurrences and the least amount of side effects. If I sound biased, I am not ashamed to admit that my sex life is as good as it was prior to BT with only a diminished amount of ejaculate and a penis that was not shortened.

It is your choice and, of course, we will all back your final de is ion and stick by you no matter what treatment you choose.

Regarding HDR brachy, it would be done as a mono therapy with your diagnosis. Or at least it typically would...when done in conjunction with IMRT it's for high-risk cases like JNF and myself. Is HDR brachy off the table for you at this point? There's tons of long-term data on it.

Re LDR brachy, it's interesting that you couldn't be cremated in Canada--although unless you live a dangerous lifestyle, I'd think your odds of dying in two years would be pretty low. Re your grandson, I can understand your reluctance there.

One of our most knowledgable posters has info on brachy and ED...hopefully, he'll weigh in, but as I understand it the risk of ED that is attributable to brachy is rather low.

Works out, the clinical trial is 2 rounds of HDR with no external beam. Apparently that is new. I have not seen anyone at Sunnybrook yet but am expecting an appointment at Princess Margaret soon.

MichaelT, the HDR is not off the table but it comes with 15 sessions of external beam ;that is what worries me, the effect on other organs. I am not sure why external beam is necessary with intermediate diagnosis and low volume. LDR does not have any additional external radiation but then I will be radioactive for 3 months.

JNF, what side effects should I expect 6 years post HRT? ED, Incontinence, bowel?

RO said with LDR I would be off work 6 weeks, swelling of prostate from the cathaters that impact the prostate below the scrotum will be painful and urgency needs to get under control.

Every option is a crap shoot. Need to get to the next appointment with the robot surgeon, I checked him out and seems to be the best. I need to get to the other side of this, my staff have seen a change in me the last few weeks. They do not know anything but I am clearly distracted or as they say, not myself.

I had only minor side effects from the HDR and all cleared after a week. IMRT side effects also cleared very quickly when they stopped. Overall I have no negative side effects at five years. The biggest effect of the radiation is that not there is very little ejaculate. No ED, incontinence, bowel problems at all. The HT portion gave me hot flashes and weight gain and body hair loss. Now the flashes are long gone and I am down 10 pounds with a few more to go. I am even now getting a little hair on my chest again. Overall I am in wonderful shape given the amount of treatment. You are 7 years younger than I was at treatment so I expect you to do better.

I can't believe a rad onc would say six weeks off after LDR. That's BS. Surgery patients go back sooner. Many men I know played golf the next day. I sure could have easily. I missed only three days of work due to all the treatment, one for a colonoscopy, and one for each of the two HDR procedures. The insertion of the catheters for LDR and HDR are essentially the same. I had no swelling though my entire groin area did turn very dark blue as there is bleeding and it settles in the groin area. Talk about blue balls!! No reason at all to be off work that long even if your work is physical. What type of work do you perform?

Hello New,

and, good luck to you in whatever treatment option you pursue!

I suffer from painful orgasms, radiation induced cystitis and proctitis, and am at 11 months post treatment.


Before I had the low dose brachy implants, and external beam radiation treatments, all the doctors told me of a "chance" of all the side effects that I ended up with, but said it's rare to have the more severe side effects.

But, now that I actually suffer from those more severe side effects, the new set of doctors that I see, say it's "common" with a smile-

I can understand why guys might want to keep quiet about the symptoms I'm enduring, since it's rather embarrassing to even mention around most folks you see on a doctors visit. But even a place where cancer patients can chat openly from behind their computer screen, there's always the guy with no side effects at all, who wants to place blame either on the patient, or their doctor...


Oh well...

I don't regret my treatment decision.

I can still satisfy my wife, and that's important to me-


Plus, I personally know a few guys that suffer similar to this poster, after surgery-

https://www.healingwell.com/community/default.aspx?f=35&m=3602224

This is a case study in why we should only speak to specialists about their own specialties. I know it's hard when a man in a white jacket is confidently asserting what turns out to be misinformation. I truly believe he thinks it's true. Were you able to get a referral to Andrew Loblaw?

I am LOL about the cremation thing. I assume that's because of the titanium-coated seeds (it can't be because of residual radiation which by then will be negligible). I have a titanium dental implant - does that preclude cremation for me as well? I guess you can put it in your will that the undertaker should remove your prostate first.

- Allen

Newtopic,
I had LDR brachy 5.5 years ago. I stayed in the hospital one night, missed 2 days of work, and was back in the gym in one week. There was some discomfort during the 'hot period' which lasted for about 10 days or so.
Currently, my sex life is excellent as is my continence. Every time I make love with my lovely girlfriend, I thank God that I made the choice that I did. I didn't and don't know much about HDR, but it sounds very good also. I never did and never would have considered surgery.
Best to you, Brother.

PS...I don't know about the cremation thing, but I remain more concerned about my quality of life on this side of the turf.

Hey Newtopc, are you bringing someone with you to these appointments, or are you going it alone?

I'm not sure you are keeping the treatment guidlines separate from each other.

HDR and LDR are both used at Sunnybrook and Princess Margaret as both Mono-Therapies, and Radiation Therapy "Boosters" for EBRT.

HDR + 3x5 sessions of EBRT is not a bad plan in my view seeing as your PSA and Bx's over the years have been progressive. In all likelyhood, the CP may also suggest a short-term ADT. Triple play is triple play....and data suggests it is very effective for low-to-high intermediate risk PCa.

Although the healing plan of RP is standard 6 weeks, LDR and HDR are "If you feel good enough to continue your normal activities the next day, then do it....but avoid heavy lifting for 2 weeks"

With the LDR, I believe the half life is 6 months? After 18 months, all you have is titanium pellets.(Wasn't aware they use titanium....but maybe that's why the half life is so short)

With HDR, there is no half life. The heavy seed is only cycled through the catheters, and not left in the patient post treatment. It is a very localized irradiation, which is why it is "typically" followed up with something a little wider in dispersion, but to a lesser dose than what would be used as a mono-therapy.

Just to add my 2 cents. I had the robotic last year and I'm very happy with the results. Unfortunately there is no right choice for everyone. I would say to do your research, find the best doctor available and go with your gut.