Brachytherapy - question about urinary screening..

Good morning,
You may be well served to take a step back, and reevaluate your direction. You have no comorbidities, are otherwise enjoying good health, and have decades of life ahead. Each incremental prostate therapy will leave you with their accumulated negative side effects, if any. I wish you the very best in your future years.

My experience is somewhat similar. I have Gleason 8, pni, and cribriform morphology. Realizing that brachy + Ebrt + ADT was my best option, I started my consultations.

JH radiation oncologist did not recommend seeds because of a median lobe. Thoughts were that the seeds would pose long term urinary risks. Did not consider proton beam. Cyberknife did not seem to have an established track record with high risk PCa. Initially consulted with 2 ROs regarding HDR. Neither was overly concerned about urinary risks. One was concerned about bleeding of the median lobe.

Decided to consult with Dr Alvaro Martinez, an early HDR pioneer to address the urinary and/or bleeding risks. Dr Martinez wanted a volume scan sonogram to check the pubic arch and trajectory of the urethra. It must be a bit of an unusual test, because I couldn’t find a doctor locally (Atlanta) that would perform it. I ended up flying to Michigan for the scan.

Also, my self urinary score was 11. Dr Martinez said that was low enough. Originally, prostate size was 67 cc; ADT fior 2 months has reduced it to 42 cc.

After many twists and turns (including a Covid delay last week), I am scheduled for HDR on Feb 16, Ebrt following.

Hopefully, any urinary issues will be non existent or short term. I’ll have to let you know.

But my understanding is that HDR may be less irritable to the prostate swelling because the radiation source is removed after the process (vs seeds).

That was a good explanation JNF.
I have heard the HDR thing before but did not understand the explanation.

Depending on the doctor, it's probably less than a month after the initial consultation. But mine has been a long and frustrating journey. I decided on the treatment the week before Thanksgiving. It would normally been 3 weeks or so to get it set up, but my original doctor practiced out of a large hospital system in Atlanta that was/is in a contract dispute with Anthem/BCBS. We informed me that he couldn't treat because we couldn't finish before the end of 2021. Because of the delay, I started ADT in early December, but even that was delayed for a week over insurance bureaucracy.

We applied for a continuance of care with original doctor and looked into other possibilities (like a cash payment), but every road seemed blocked. Finally, we got things worked out in Michigan in early February with Dr Martinez - then a Covid delay.

So, I'd guess it's usually a month or so if the doctor can work into the schedule. Don't try it my way:

gh - "don't let perfect be the enemy of good".

Your G7(4+3) diagnosis is where I started and is not the best news. My urologist said take a couple of months to figure it all out after recommending surgery but don't wait too long as it is a riskier diagnosis. He was booking out 4-6 weeks at the time depending on surgery location.

Radiation was started 2-3 weeks after I made that decision but starts with the scans, preparing the radiation plan, etc. I had met with the RO before I went on a vacation and made the decision when I returned which helped speed up things.

This was all pre-Covid so there were times during Covid that lots of things got delayed but radiation was less sensitive to delays than surgical procedures requiring overnight stay.

If you go to any of the doctors and tell them that you have prostate cancer that needs to be treated, they will outline a plan and schedule it. Pick something and get 'er done.

gh - I am not so sure that trying to pass the urine test is a good thing unless you get a nice gift at the end. They really want to know how significant the issue is for treatment considerations.

Surgery and IMRT beam radiation (standard vs. hypofractionated or Photon or SBRT) are straight forward. The doctors know exactly what to do and their systems will process you fairly quickly. It gets trickier when many conditions are added.

I think the standard protocols for G7(4+3) are surgery or ADT/IMRT radiation assuming no other risk issues. Triple play is generally intended for higher risk cases. If the LD Brachy is getting too complicated, you can always drop back to the standard schemes and forge ahead. I like the concept of HD Brachy but it can be a little more difficult to find the providers than the standard treatments.

I wish you all the luck with this and hope you see a way to get it done soon.

I'm not qualified to answer your question about complications groundhogy, but please forgive my ignorance with this levity. One doesn't wear a foley catheter. A foley catheter is akin to having your penis on a skewer.
I also enjoyed the ribbing mumbo made about getting a nice gift for passing the urine flow test.

gh - Let's look at a it a bit differently per Mayo:

Complications of untreated prostate cancer
Trouble urinating
Decreased force in the stream of urine
Blood in the urine
Blood in the semen
Bone pain
Losing weight without trying
Erectile dysfunction

Needless to say but untimely death is the last side effect for younger men. Many of the items above can be treatment side effects as well but most are temporary or can be treated if they develop. Sure, a few people die from surgery and a few get secondary cancers from radiation treatment but there is more risk driving to your appointments than those occurring.

Your doctor can/will provide you the possible side effects (or complications) of the selected treatment(s) and the probability of occurrence which is all they can do. You have to evaluate the significance to you and make the decisions.

I had LDR brachy 10 years ago and have a large median lobe prostate. My physician told me the risk of urinary retention was higher than without a median lobe but in his experience had never experienced urinary retention. I also had IMRT radiation but did not receive hormones. I did not experience any retention issues and have not had any significant problems since the procedure. I have been thrilled with the results. However, ten years ago, SBRT and HDR brachy were not a readily available and did not have the literature support yet. Now they do and have been shown to be at least equal to the results of LDR. If I were to select now, I would probably either choose SBRT or HDR because of the increased risk of LDR brachy.

Good luck,

Paul

groundhogy, I agree with Tudpock, you are asking a lot of questions which is great. However, it is tough to answer your questions without you giving a history of your diagnosis. That would include, PSA results, any scans and biopsy results. You seem very concerned about after treatment SEs which is also a top question most have depending on the treatment choice. My concern in your case is how long it has been since your first DX. I am a GL-8. I couldn’t receive seeds due to a previous TURP procedure. I had IMRT and ADT my SEs are minimal and I have had no burning during urination. IMHO, it is time to get going before your choices become more limited as mine did by waiting to long. My best to you,
Jack

Oh thats good news.
Hope it continues!