Candidate for brachytherapy??

That's ridicules. Three months of Casodex will shrink it to below 25cc. You may need an external radiation boast as It's a 4+3 with a lot of cancer volume, but that's not a big deal. There is nothing else you mentioned in his data that should exclude brachy.

I am not a doctor, but I don't see anything that would preclude brachytherapy, either permanent seeds or High Dose Rate temporary. HDRBT can easily be used with prostates twice that size and we have men on the board that successfully used permanent seeds with much larger prostates.

I agree with JohnT that adjuvant IMRT/IGRT might also be in order. In addition to Casodex both Avodart or Proscar will shrink the prostate 35-50% within a few months. These are often used before brachytherapy to better prepare the target. All very standard practice.

Since you haven't yet met with the radiation oncologist that will actually perform the brachytherapy, I suggest you not get worried about what the other doctor said. In this case he is not the expert.

Jackie, I think you have received excellent advice so far. As big a fan as I am of LDR Brachy, I think with Gil's stats that he would likely need to have the prostate shrunk AND add a course of IMRT on top of that. Rather than that, I also suggest HDR Brachy and SBRT as mono therapies for his cancer.

Jim

Protons is not the same as Photons. Protons is what is available at Loma Linda and is NOT covered by the VA and many insurance plans. Photons is available everywhere else, and IS covered by the VA and all insurance.

jackiespino said...
LDR is permanent seeds -- have them inplanted and no 'treatments' for it? HDR is temporary seeds still but treatments as well? I'm not talking about the radiation that may or may not be recommended after the brachy therapy -- just these 'seeds' that I'm trying to wrap my head around better.

I do not know what you mean by "treatments." Could you please explain? Do you mean hormone pretreatments? If so, you are correct that it is unnecessary to shrink the prostate first if he is having HDR brachy. He may require hormone pretreatment if he is having LDR brachy, although with a 44 cc prostate, I think most ROs would go ahead without hormone pretreatment. If you mean external beam radiation, that will probably be necessary with LDR brachy, but probably will not be necessary with HDR brachy. Neither hormone treatment nor any other external beam treatment is required with SBRT.

These are very good questions to ask the experts in those therapies.

With Medicare open enrollment beginning in just 3 days (Oct 15- Dec 7), this would be a good time to make that decision. It would give him access to top rate doctors and treatments that he could not otherwise get. He can always go back to VA only the following year. Just today, I spoke to someone from the California Health Insurance Counseling and Advocacy Program (HICAP) and she was very helpful in laying out my Medicare options and the costs. The number is (800) 434-0222

To add to what TA said about signing up for medicare....

If I understand you correctly it appears your husband did not sign up for Medicare Part B 8 years ago when he was first eligible because like me he gets his care at the VA. That means he will have to pay a 10% per year penalty or 80% of the current premium of $134.00 which would be about $121.00 and his monthly premium would be about $255.00.

Because he didn't sign up during open enrollment back when he was 65 he will have to wait until what is called the General Enrollment Period which starts Jan 1, 2018 and runs to March 30, 2018 for coverage beginning July 1, 2018. He would not be eligible for a Medigap policy when he starts medicare due to the cancer diagnosis.

He will have to wait until next years open enrollment period in October 2018 to sign up for a medicare advantage plan for coverage that will start January 1, 2019. The only good news would be that he can enroll in a medicare advantage plan irregardless of his health unlike medigap which requires medical underwriting, but its rumored that may change in the future.

Like your husband I didn't sign up for Medicare Part B when first eligible because I had been getting my care for years through the VA and was very satisfied with it. However, I've realized that the VA may not be able to care for all my medical needs going forward as I've moved from the city to the country so I started looking into Medicare and discovered the penalties and waiting periods I've described...

No, there isn't anything he has to do after any cancer treatment. With LDR brachytherapy, he should have a CT scan within a month to make sure the seeds ended up where they were supposed to. There may be some side effects of the treatment. For example, he may feel some burning when he pees, and he may have to pee frequently, and he may notice some blood spots on the TP after he poops. But they should disappear after a little while, or he may get some medication if the side effects are annoying. After the side effects disappear, the only thing he has to do is get a PSA blood test every 3 months, at least for the first year. If all goes well, his PSA will drift downward over the next few years. That's a sign that he has been cured.