IMRT + HDR brachytherapy?

Thanks Dogdays. I got a second biopsy reading from John's Hopkins - it differed on one core only, changing a 3+3 to a 3+4 (10% 4). I've also had a CT and bone scan, both clean.

After bouncing up and down for a couple weks, my sanity level is as close to normal as it's going to get, since I'm nearly certain on the treatment direction. The hard part now is waiting for the MRI - my prostate has to heal enough from the biopsy first. I also have to switch primary care physicians to get the RO I want, but that's just a formality.

I know it wasn't what you wanted to hear, but it really doesn't change brachy boost as an excellent treatment option for you. HDR brachy has an advantage with SVI because, unlike seeds, they can treat there.

What is "SO"?

So, soon it begins. I'll be on Firmagon for 2 to 3 years, IMRT a couple months after that starts, some kind of brachy therapy after that.

One step at a time. Deal with the initial injections, then with the SE's. Life will never be the same. .. but life it is.

Ideasave, it's a long war made of many battles. You're doing great on the first one, figuring out what to do. From there, it's one after another, sometimes day by day, even hour by hour. You can do it.

My HT was based on Lupron, and Casodex, as a high risk G9 case. As a T3 stage you're now in one of the high risk categories and that's likely the driver for the much longer period on HT. There are several ways to do the HT medically. Receiving Lupron was easy to do , for much of my time on it just having one shot every six months. A slightly achy butt cheek for a day, and then fine for six months. Just FYI.

All the best to you.

Thanks everybody. The advice and words of encouragement/reassurance I've received here and in other threads are actually the first treatment in my journey, and I count that as the first success!

Regarding the different HT drugs, my doctor's immediate goal is to deprive the cancer of its food ASAP, and Firmagon appears to do that the fastest. There is supposed to be a huge drop in testosterone in one day, reaching 97% after three, with no initial spike.

That makes a lot of sense. It's my urologist who recommended the Firmagon, so I'd already planned to discuss that with my RO. I will now definitely ask about such a switch.

Losing weight on HT is pretty impressive! I had to work at things just to keep my weight steady.

FWIW, I had my HDR brachy first (at UCLA), but it seems like the somewhat more common protocol is for IMRT to go first.

I consulted with Demanes, although my procedure was done by Kamrava who was his #2 (at the time). Kamrava has since moved to Cedars to start the HDR brachy program there and--as I understand it--Demanes has come out of retirement at UCLA.

When I had the treatment done four years ago, the whole HDR team had been together working for Demanes for many years--it was a very well-oiled machine and there was great teamwork. Hopefully, the core group there is still together.

-Bump-

IdeaSave - I am seriously considering the same treatment, can you offer any additional insight... good or bad observatins, what you might change etc... since your last update? Thanks much.