RO states almost no difference in ED rates between RP and LDR Brachy

brava said...
I just met with the radiation oncologist at John Hopkins University. He stated that there is literally no difference between ED rates between radical prostatectomy and ldr brachytherapy. I was shocked. I almost hauled my arse out of there. I think Fox Chase is going to be the place for me. Any advice would be helpful? I'm really trying to pursue this HDR Brachy option and it seems like choices are severely limited. Another rectal probe for nothing.

Well, he should know, but that sure sounds screwy to me, and even screwier if regarding the 1st 5 years, as some RT damage shows up later. But based on friends locally, and the folks I have seen posting at HWPC, I get the impression there is a large difference. IOW, lots and lots of RP folks complaining about all things sexual, and very few of the RT gang complaining. But that of course is not a RCT study.

I'm not one of those guys that can pull out studies or quote statistics, but one of reasons a lot of guys pursue HDR brachy is because of a lower incidence of ED.

If you do the HDR route, it might be practical to travel for it. I know a few folks that traveled to UCLA for it and I'm sure that others here have traveled to specific HDR brachy practitioners.

I love you guys. It's like having a whole bunch of younger and older brothers looking out for you. Chase and MSKCC nect. the hotel prices in new York are off the chain.

Brava, yeah..."truthiness" is a good word for what that RO told you. The devil is always in the details and thank goodness for TA who always has the data at hand! Another study that supports what TA wrote was published in the New England Journal of Medicine in 2008...that's a little dated but I reference it because it was a big influencer for me when I made my BT decision. Just Google "New England Quality of Life Study" and you will find it. This showed at clear advantage from the patients' perspective for less ED in BT patients than in surgery patients.

Of course individual results vary with diagnosis, doctor and individual circumstances. But it's certainly clear to me that the radiation options offer a clear advantage when it comes to the key side effect of ED.

Jim

Brava,

I have my Fox Chase Brachy consult in April. I guess mine will not be a LDR consult, but a HDR consult.

I am really concerned about ED issues. My concerns about incontinence are not as great. I feel that I could regain that because of age and overall good health, but fear total ED. But, I need to balance that with the possibility of a true 'cure' and living a long life. Surgery may offer that, will Brachy and other radiation offer that too? I don't know.

Brothers, can radiation (of any kind) actually cure a G4+3 if contained? Can it actually 'cure' a G4+3 if it is not contained but somewhat localized? Is there anyone out there that is 10-15 years out and is pulling non-detectable PSA's with radiation as their primary treatment option?

J

My husband had Brachytherapy (diagnosed in 2005, surgery in 2006), it was his sole treatment and we're deemed to be clear. Not sure if we're the longest out or not, but long enough to answer your question in any event.

Jay,
I had an aggressive 16mm by 18mm G4+3. I haven't gone 15 years, but I've done 7. My psa is still dropping as it is below .05, down from 40. So yes, radiation can cure aggressive cancer with no side effects. Radiation leaves the prostate fallow, which means that future cancers can't grow from radiated prostate tissue. Most radiation reoccurrence are systemic, meaning the cancer is outside of the prostate and already was when treatment started.

John T,

My local Uro told me that I was ineligible for "seeds" because of DRE+ and 4+3. Looks like you got them. I wonder why he told me that?

Anyway, it really doesn't matter because I am going to a pretty good Brachy place (Fox Chase) for a consult.

J

My husband investigated three options - removal, external beam and Brachytherapy. He knew he would not be able to sit still for the full recovery time for removal and the results were equally as good with Brachytherapy so he chose that route. Princess Margaret is an excellent hospital, equally as pleased with his surgeon Dr. Juanita Crook who has since moved to practice in British Columbia. Truly blessed to have such a forward thinking doctor. Oh, and it goes without saying, check your vanity at the door LOL - all of my husband's prostate doctors and nurses (except for one) were female!

I have a business partner that had LDR brachytherapy and IMRT 17 years ago. He was a G7, but didn't tell me how much volume. He is undetectable, continent, sexually active and 72 years old.

Please stop listening to the uro about treatments that he does not specialize in. Get thhe info from the specialist in each area.

Jay, what about brachy treatment? . I thought you were going to go to Fox Chase? I'm heading there on Monday.

After all this rectal probing I need somebody to hold me (lol). Nicholas. Why does every practitioner think they need to stick their finger up my ass. I think they just irritate the cancer. The cancer is sleeping, it's chilling out by itself minding its own business and all of a sudden all these probes are coming in waking it up, disturbing its sleep. I'm one of there been any studies about the increase in spread of cancer and how many fingers people sticking you. I am so sick of it. This is mental exhaustion like I've never experienced in my life.

I'm not too cool with HT because my research has led me to find out that yhete is a chance of heart problems. Just be careful with HT. I'm sure it's cool that doctors are recommending it but that itself is nervous. This will be my 5th meeting on Monday. I gotta do something soon

Brava, I would not be currently concerned about ADT risks as you do not appear to be a current candidate for long term treatment. Low PSA, low cancer involvement and G3+4 does not indicate ADT as a long term treatment. What has been commented is that an initial short term use of casodex or Avodart can be used to shrink the prostate and make it a better radiotherapy target. It is also common that an initial three month course of Lupron can improve the radiotherapy efficacy.

But these uses are not what can lead to greater chances of heart problems. That comes from the men, like me, who have had long term ADT treatment. In my case three years. Due to the lower testosterone our metabolism changes and most will gain weight and then have difficulty losing it. It is this added weight that can contribute to greater risk of heart problems just the same as those men who carry too much weight though were never on ADT.

For you a very short course that will help the radiotherapy be more effective lowers your risk of recurrence. If there is no recurrence then you would never have to go on ADT for long term therapy. Short term use does not typically add the weight and generally this is not a side effect of casodex or Avodart.

As you are reading about potential side effects and future risks, please be careful not to read with such a broad brush. Look for the risks that are specific to your own situation. Even if you do have to use ADT long term you can be one of those men that more successfully manage their weight so that they are not at a greater risk.