IMRT then LDR-BT or LDR-BT then IMRT?

Balladeer,
I researched this 10 years ago and spoke to quite a few ROs. It doesn't matter and is a personal preference of the RO. I had it done before with excellent results others have had great results with it done after.
One advantage to before is that they use the seeds or implanted markers to guide the radiation beam.

but, when pouring a cup of tea, is it milk first then the tea or tea then add the milk?

Balladeer, I had seeds first. forty cesium seeds. I just began my ninth year of remission, post treatment. all 12 cores were positive on biopsy. one was 70%.

my doc was Steven Kurtzman who has treated more then 5000 men for protate cancer with BT.

/isoray.com/2017/02/cesium-131-brachytherapy-patient-experience/

sorry to piece in my reply but trying to get this link to work is frustrating.


Fixed the link for you F8

Post Edited By Moderator (Pratoman) : 7/24/2018 3:40:26 PM (GMT-6)

most of that info is in my signature. G = 3+4, prostate was normal, 12 cores positive. intermediate to high risk.

both of my treatments were through The Northern California Prostate Cancer Center in San Jose, Ca.

as I recall there were about three months between BT and my the beginning of IGRT. but it could have been two months. i'll ask my wife later.

**update** wife said one month between BT and IGRT.

F8 said...
. . . as I recall there were about three months between RT and my the beginning of IGRT. i'll ask my wife later.

Excellent. Thank you for the added info.

With 50% more energy and 50% shorter half-life, Cs-131 seeds would have far less emissions at 90-days out than would Pd-103 seeds. In fact, they're reportedly undetectable at 97-days (versus 107-days for Pd-103). This means that at the time you received IGRT (if it was in-fact at 90-days), there was negligible overlapping radiation in your case, making the order of treatment inconsequential. Or, to continue in the local vernacular of the hood, it means that you could join the other scholars here and add tea to your milk or milk to your tea.

In my case (with Pd-103 seeds), the equation is entirely different. In my case, the proposed IMRT sessions are scheduled to begin less than 5-weeks (just 34-days) after LDR-BT, when well over HALF of the total seed energy will still be present (58-days to 90% dose), making the prospect for overlapping radiation from the early-stage IMRT sessions a virtual certainty, and thereby increasing the potential for adverse side effects to non-target tissues. This is precisely why I initiated this thread to begin with, and its precisely why I've pushed the issue here, because its painfully clear (at least to me), that some folks are simply not grasping the concept or consequences of radiation overlap.

Thank you again for responding and best wishes for continued success on your remission journey.

Fauntleroy said...
Can only speak from my limited one time experience with LDR Brachy, once was enough thank you, but when I started I had a urinary issue and an enlarged prostate, I would not have made it through brachy first.

Thank you, Fauntleroy. I'm sorry to hear that LDR-brachy was a struggle for you, but yeah, as I understand it, urinary issues and prostate size can both play a definite role in qualifying for LDR-BT, as well as post-OP side effects. Fortunately, in my case, I don't have any serious urination issues and my prostate volume is qualifying at <50cc. Plus, I will have been on Casodex and Lupron (both) for an extended period preceding the seed implantation process, which were prescribed specifically to shrink the gland itself, so if freedom from urination issues continues for me (knock on wood!), I should be in a somewhat better position than you were back in 2013. But I certainly won't reject prayers on my behalf from anybody!

Balladeer:

You are not going to find anything approaching the definition of "proof" that indicates one sequencing of brachytherapy is better than the other.

Participants in this forum, including Tall Allen, routinely assert that doctors often adopt theories of treatment and procedural practices without real evidence to support their choices, and suggesting that patients' involvement in decision making is in their best interest.

Your doctor, while describing his normal sequence, has said he will do it in the reverse sequence, suggesting he sees no significant therapeutic difference.

Frequently, doctors avoid detailed discussion for time management reasons, since many patients just follow their lead without hesitation. Time is money.

Since nobody, including your doctor, has put forth any theory about why your preferred sequence is inferior, I suggest that you just tell your doctor how you want to proceed. If your doctor has any basis for his preference, he will enlighten you.

'"Now i know how you became such a talented Photographer - it was Kurtzman!!! yeah

BTW, following you on Instagram"

I love that guy. he was so sure of himself and from what I understand in demand. he and the other doctors at the radiation clinic were just great and so far everything has gone just like they said it would.

Doh!!! This discussion just continues to 'astound' me! Over this past week, everyone and his uncle here have erroneously jumped to the assumption that I believe in and "prefer" a particular order to things, and that I wish to dictate my "preferred" protocol or sequence, or possibly opt for an entirely new and different oncologist altogether. Where on earth is this stuff coming from? It certainly isn't coming from anyone whose read my earlier postings about how pleased I am with my RO and his suggested approach to my treatment. It certainly can't be coming from anyone whose tracked my expressed concerns about overlap radiation.

Perhaps I worded things a bit improperly or too harshly in my initial posting about potentially "requesting a reversal of treatment", etc., and if that's the case, I'll gladly own that. In fact, looking back on that posting now, I can see how this simple little ripple of a question, could slowly morph into just such a tsunami. But let me try again to be absolutely clear here . . . I do NOT (personally) believe in or "prefer" a particular order to the two treatments. Don't, and never did! And I'm gonna say that again, just for those who seem to be struggling with this . . . I do NOT and have not, believed in, or preferred, a particular order, period!

What I prefer is to NOT have my bladder and/or rectum 'potentially' over-radiated by excessive overlap radiation, and I have thoroughly outlined (above) just how and when that 'overlap radiation' is likely to occur, given my current (proposed) treatment plan. I could not possibly or conceivably have made it any clearer than I did. The one and only biopsy and 3T-MRI results in my history show the tumor to be quite sizeable and located at the right base, placing my bladder (in particular), at increased risk of non-target exposure. And for reasons that should be obvious to all, I'd very much like to avoid that prospect, if at all possible. Suggesting a reversal of the two treatments was and is the simplest, fastest, most sure-fire way to eliminate the potential for radiation overlap. That's it, and that's all!

Now, do I plan on discussing this issue with my RO the next time I have access to him? Yes. Do I plan on dictating or insisting on any changes or "preferred" protocols to him and his crew? No. Am I unhappy with my RO in any way? Do I question his judgement or distrust him? Do I plan on shopping for another? No, no, and no!!! Do I think having LDR-BT prior to IMRT makes sense from a mapping perspective? Yes. Do I agree that both approaches are widely used? Yes. Do I agree that both methods offer equal success rates? Yes. Would I be happy with either approach? Yes. Am I convinced that overlap radiation might occur in my case, as it is currently planned? Yes. Would I like to see a greater period of time between the two treatments to minimize such overlap? Yes. Will I express that concern to my RO directly when next we speak? Yes. Will I dump him if he disagrees with me? No. Is he likely to get defensive or ridicule me for asking such a question? No. Is it possible that unbeknownst to him, his support staff simply scheduled the two events too closely together? Yes.

Lets see, have I missed anything here? Is any of that helping, anyone, at all?

John T said...
Balladeer,

I did have LDR Brachy before IMRT. My psa went from 40 with a G 4+3 to .02 and stayed there for nearly 10 years. I have zero side effects for the last 10 years. The RO is much more important than the order of the procedure.

John,

Thanks for continuing to participate here, and I agree completely. I'm very happy with my choice of RO, and I have nothing but total confidence in him and the likely outcome of things. I'm particularly pleased to hear that you suffered no adverse or long-term side effects.