Doctors that won't do HDR Brachytherapy?

Hmmm, I'm not so sure re ASCENDE-RT...at least in terms of survival. Here's some info on that: https://prostatecancerinfolink.net/2017/03/16/brachy-boost-the-gold-standard-for-progression-free-survival-of-high-risk-prostate-cancer/.

Does UW do HDR brachy for other cancers? I'm curious if they don't offer it at or, or if they don't find the value just for prostate cancer patients.

I would find another practitioner who offers it. Get their perspective. A lot of centers dont offer it because it isnt the most profitable. They also require a facility to do the treatments and house the after loading equipment.
My understanding it is one of the best treatments for high risk patients.

Tall Allen had much to say about this. Seek him out elsewhere, or search this forum's archives. The general consensus after a lot of sturm and drang was that adding brachy generally improved cancer control, offset by an increased risk of side effects such as urinary strictures.

Vanderbilt's Cancer Center, back in 2013 when I was treated, also was not in favor of brachytherapy addition. They're a regional referral center for those suffering side effects from treatments elsewhere, hence quite aware of those outcomes. I pushed for brachy myself back then, and my RO made pretty much the same comments as the UW doc. My RO said that Vanderbilt does brachy, and if he thought it better for my case that he would do it; he didn't. He made the same argument, that the benefit doesn't justify the side effects.

Keep in mind, while "urinary stricture" sounds a little medical, a little sterile, living with that problem can be difficult indeed. But still, when making any treatment choice it's a personal decision whether to role those dice or not. If you pursue it, you can find a doctor or team of doctors to do what you want done.

This topic led to considerable disagreement on this forum, becoming a bit ugly. I wouldn't suggest we let that happen again.

I used HDRBT+IMRT+ADT very successfully for high risk PCa. I have complete cancer control after eight years and no negative treatment side effects.

There are several practitioners that use the combination. You can go to UCLA where the HDRBT all started with Dr. Jeffrey Demanes back in 1981. You can come here to Atlanta where we have two high volume clinics using HDRBT every day for PCa. You can go to Detroit and see the HDRBT expert Dr. Alvarez Martinez. It is a great treatment method and can work for you. You may have to do some more looking for the right provider.

From a doctor’s standpoint it is essentially the same skill set as permanent seeds brachytherapy. HDRBT requires additional radiation equipment called the afterloader and requires the physicist, dosemetrist and technicians to be trained and experienced. Old fashioned IMRT/IGRT is the most profitable for the doctor and least convenient for the patient. HDRBT and SBRT is the most convenient for the patient and least profitable for the doctor. Go figure.

Sr Sailor said...

Finally, and as often stated, it's important to choose a doctor who has done many HDR brachy procedures.

Will second that. I had made the decision that whatever procedure I decided on doing would be done by a very experienced provider. And since compared to other procedures there are few doctors specializing in HDR brachy, deciding on this meant traveling to have it done, which I decided was worth doing.

Bob, This spring I will be looking for a good urology oncologist in the Seattle area, probably the UW. Sounds like you've met them. Any recommendations? My second biopsy up'd me to 3+4, Grade 2. Have been on a year of AS but will be eyeing Brachytherapy.

Thanks. You and anyone else can respond here or via email in my profile.

-Doug