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Question about brachy therapy

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Prostate Cancer
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Posted 12/1/2021 5:33 AM (GMT 0)
Hi
I am new this forum although I was diagnosed with prostrate cancer 4 years ago. I just had a MRI assisted biopsy and my cancer has spread to other parts of prostrate. My Gleason score is 3 plus 3

My oncologist recommended brachy therapy, either seed implants or high dose rate (HDR). Does any one have an opinion as to one versus the other? I am leaning towards HDR.

Also if I qualify for HDR, how long will I have to undergo treatment. From on line searches I gather its pretty quick, tops 3 -4 days but my oncologist suggested i cold take six weeks, is that right? This is an important issue for me as I live on Saipan, a US Territory near Japan and Guam, and I will have to fly to the Mainland for treatment. My OR refuses to respond unless I see him in person which since I live half way around the world, isnt a very helpful response.

Thanks very much

Dave
Posted 12/1/2021 1:32 PM (GMT 0)
Hard to believe, there is a fellow, Saipan Paradise, that you can use the search bar for to find his posts and email. He might be able to help with the journey from afar.

No direct experience with Brachy but I would go for HDR which takes maybe 2 weeks and leaves nothing in your prostate.
Posted 12/1/2021 5:43 PM (GMT 0)
In a case like yours, experience is what matters most.
There must be studies comparing seed brachy to HDR brachy.

Did your oncologist explain why HDR brachy would take so long for you? To my (superficial) knowledge, HDR brachy requires two hospitalizations; usually a few days apart.
Posted 12/1/2021 7:52 PM (GMT 0)
Welcome to the forum and you have now doubled the number of Saipan members in our community!

When I had HDR brachy in 2013, it consisted of two different overnight hospital stays one week apart. At UCLA where I was treated that protocol has changed and I don't believe there are any overnights anymore. I'm sure guys that have had the procedure more recently can weigh in.

For those of us that HDR brachy in conjunction with IMRT (that's me), the IMRT portion added on an additional five weeks of treatment. But with your Gleason 6 diagnosis, you would have HDR brachy as a mono-therapy--IRMT would not be involved, so I don't see any way that this could possibly take six weeks for you.

I'm certainly a supporter of HDR brachy since it worked so well for me. But with a Gleason 6 diagnosis, I would expect the cure rates to be the same with either HDR or LDR. (And that cure rate would be very, very high.) Do you have access to each procedure--generally a radiation oncologist or a specific facility would offer one treatment or the other, but probably not both.
Posted 12/1/2021 8:06 PM (GMT 0)
David,
I'm thinking you have been doing AS these past four years?
Posted 12/1/2021 9:06 PM (GMT 0)
Hello David and welcome. LDR Brachy is not as common as it used to be as it's not as profitable to the providers as other options. However, it a patient qualifies, it's an excellent treatment that will cure your cancer as well as other options. Arguably it's also the "easiest" option. After the planning session it's simply a one-treatment out patient procedure.

The main qualifications are a prostate contained cancer and a normal sized prostate. Here is a link to one of the best known LDR practitioners in the mainland USA: https://www.chicagoprostatecancer.com/ This will provide you with the basics.

I had LDR Brachy 13 years ago and you can read my story by copying and pasting the link in my signature. I've been cured for many, many years and have zero side effects except the normal reduction in ejaculate which almost all treatments yield.

Good luck to you.

Jim
Posted 12/1/2021 10:34 PM (GMT 0)
HDR Brachytherapy for a low risk man like you should be done in one fraction. Start to finish about 4-5 hours as an outpatient and no urinary catheter will be left in. I had HDR-BT eleven years ago. I had two fractions one week apart, both on an out patient basis. Now most practitioners are using higher dose rates and often using only one fraction and never a hospital stay.

I have no idea why the MO would refer to six weeks of treatment. That would be the case for traditional low fraction external beam radiation, but not for brachytherapy. It may be the the radiation oncologist will want you to take a short term shot of ADT like Lupron or Firmagon and then a month to six weeks later perform the radiation. This softens the cancer to make it more vulnerable to the radiation.

I studied both HDR and permanent seeds as I had access to two of the best practitioners in the country for each. I was, and am, convinced that HDR is the better treatment overall. HDR is more advanced in its placement and conformity of the radiation dose to the cancer. Excellent cancer control with the lowest side effects compared to any other treatment options. And the radiation is not left in the body like permanent seeds. Comparatively, seeds are good, HDR is better. I am now eleven years out from treatment and continue to be cancer free and importantly free of any negative treatment side effects.
Posted 12/2/2021 10:50 AM (GMT 0)
Yes, Saipan David and I know each other. But as a G8, I never paid much attention to the options for G6 and can't advise him on them. Thank you to all forum members who are coming to his aid.
Posted 12/3/2021 1:41 AM (GMT 0)
I was trying to figure out how to reply to each response individually but I cant figure it out,

So thanks to JNF, Tudpock, Mattan, Michael, Sr Sailor, and Mumbo for your helpful responses all and to Saipan Paradise who introduced me to this forum.
Posted 12/5/2021 10:18 PM (GMT 0)
Hi David,
I had seed implants about two years ago. I considered beam rad, HDR and seed therapy. In the end I chose seeds because of my oncologist and urologist. The seeds are supposed to be smaller than a rice grain and very well tolerated. Both the Oncologist and Urologist are present at the surgery. My surgery went fairly smooth but the next day I had severe burning when urinating. Uribel did wonders for me.

Now I am two years out and suffering what could be long term side effects which I just posted about yesterday. I am pursuing all avenues to find out the problem as I feel like I am suffering from prostatitis. I had a bout of this about every six months or so prior to being diagnosed with cancer. After seed implants I was good for about two years. Now I feel like garbage again.

I am sure whatever you chose will be great. Also many helpful gentlemen here to help you with your journey.
Posted 12/5/2021 10:50 PM (GMT 0)
Thanks very much for the post and sorry to hear you are having complications, I sure hope they get resolved and soon.

Dave
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