brachytherapy

Hello Fellow Prostates: Mine is 69 years old and and is sporting a PSA of 6.5 with a #5 Gleason. On 8/8/08 (the day the Beijing Olympics opened) I was told that 2 of my 12 biopsies had "ugly little faces". Since then I have been twiddling my thumbs and hoping that it was all just a bad dream. Bad dream for sure but I can't seem to shake it off and so I have been window shopping the various modalities. At present I've slated myself for a February 3rd Brachytherapy option which was a simple "gut level" decision. Have any of your prostates experience this and what do they have to say about it?? Blessings to you/us all. Thanks. GYW

My cousin who was 68 at the time had brachytherapy 4 years ago and has no complaints.

Dear GY, Well, Pete, my husband had Brachy , and external Radiation and lupron treatment seven years ago. After four years, We were very happy and thought he was cured. with slight incontinence and beginning to feel sexy again. Well, the cancer reared its ugly head again, and the PSA rose from .5 to 8 in six months. He had salvage surgery which has been devastating to Pete....The damage caused by the radiation caused many severe side effects. You can read his signature.
The point is: if you have the surgery, and get it out...it wont come back to the prostate....If it does come back, then you can always do the salvage radiation...but once you do radiation, that is your best shot.....After that, if it comes back you probably should go on Hormone Therapy..instead of salvage surgery....Even with the best doctors it is a difficult operation after radiation, and also there is 100% incontinence and no hope for the ED treatments to work. We went in hoping for a 40% cure, but even the salvage surgery with all of its problems did not get the cancer. It was in the lymph nodes....and is now beginning to rise again... From our point of view it makes a lot of sense to get it out first....We all want to think that it won't ever come back, but it is a gamble whichever route you take....I think it is good to leave some better options open than salvage surgery.... That being said, there are others here that have done well with Brachy. Good luck. Diane

Hello GYW:

I am the token seed guy on this forum and am glad to help in any way I can.  First of all, as you see from divo's post, things can go wrong with any protocol you choose.  I agree that surgery after radiation is not a good idea and would never consider it if, heaven forbid, my cancer comes back.  Having said that, I chose brachytherapy and, so far, am very pleased with the choice.  All my equipment works well and my life is normal.  Of course, I'm only 5 weeks post procedure, so I know that things may yet come down the pike.

Anyway, since you asked, I have cut and pasted a response I gave to another newbie on the subject.  Also, if you're interested in a more detailed view of my thought processes and results to date, may I suggest you go to my post "Tudpock's Brachytherapy Journey" on this forum.  You can access this by sorting the posts by "Started By", then scroll to Tudpock18.  You might also want to see "JustJulie's Brachytherapy Journey" that details her and her husband's experience. 

So, shown below is the cut and paste and please come back...sometimes it's a little lonely here as a seed among scalpels.

Best wishes,

Tudpock

Hi and welcome.  I have observed that most of the guys on this site have elected surgery and you will get plenty of advice from them.  My stats were not far from yours and I looked at all options, narrowed them down to da vinci and brachy, and ultimately chose bracytherapy.  My procedure was recent (3 weeks ago) and, if you are interested, you can check my thread "Tudpock's Brachytherapy Journey" on this site to see my thought process re my choice -- plus you'll see my post-op situation which is remarkably good, i.e. my life is normal and all equipment is functioning great.

 

Having said that, I wouldn't necessarily recommend seeds for you, I just know it was right for me.  I'm sure you have examined both options carefully and know the stats and SE's backward and forwards so I won't go into those except to say that, with your cancer stats as I read them, the cure rate for both options is basically the same.  There are a few other things to consider, however, that may not necessarily be in all of the books, so I'll throw them in for whatever help they can be:

 

1.  There is a personal psychological issue that only you can answer.  That is, how important is "getting it out" to you?  You'll read a lot of posts on this site from men for whom that was a really big deal.  They wanted the cancer out of their bodies, wanted to see an immediate pathology report and that was that.  For me, that wasn't a big deal at all...the important thing was to do lots of research and make an informed decision as to the right cure and the quality of life issues, then move on.  There are no sure things with either choice...

 

2.  The other issue many men bring up is that "surgery after radiation" is not really a good option but that "radiation after surgery" is possible. That is true (though some docs do surgery after radiation but it is a very difficult procedure).  There are other options after seeds that are available but you should probably assume that surgery is not among them.  If this issue is important to you, then brachy may not be your best choice.

 

3.  The immediate side effects from surgery are well known...and you can read them in spades on this site.  Re brachy, the immediate urinary side effects are generally frequency and urgency and may last a couple of months.  However, IF you don't have much of an issue with this pre-procedure, you probably won't post-procedure.  My urologist gave me a test (can't remember what it is called) that scored me on such things as number of times I had to go urgently now, number of times I get up in the night, weak stream, etc.  My score was low (that's good), meaning that I did not have issues on those functions pre-procedure.  My radiation oncologist and my urologist both predicted that my post-procedure issues would be minor or non-existant with Flomax treatment and, so far, they have been correct.  Now, remember I'm only 3 weeks out, so I may yet have some of these issues but, so far - so good.

 

4.  ED issues occur in brachy patients at a slightly lower rate than in surgery patients -- but there are varying reports on this.  However, the ED with surgery occurs immediately after the surgery and generally gets better (with pills) over time.  The ED with brachy occurs later, i.e. 2 years++.  And, as in the case of urinary effects, if your equipment is working well before the procedure, the chances are better that it will work after the procedure.  Also, if ED does occur, the same little pills that surgery patients take work with brachy patients.  For me, sex started 2 weeks after the seeding, and junior responded well with no pill assistance needed.  I'm looking forward to 2 good years and then, if we need a little help, I'll pop the pills at that time.

 

5.  There are a small % of brachy patients who have bowel issues...but it's a larger % than surgery patients.  Experience of your radiation oncologist is key here as the issues seem to vary with seed placement and dosage.

 

I hope this helps a bit.  It's a BIG decision and I wish you the best.  Please come back and let us know what you decide.

 

Tudpack is absolutely correct, and there is every reason to believe he will be perfectly fine....He had a low psa along with a confined cancer. Pete had a much higher psa and more cores with Pca......My only concern was the salvage part...which we made a big mistake having., but only on the advice of surgeons and an oncologist from one of the best cancer hospitals.. Pete and I try to tell the story only to help other men avoid the salvage surgery that some few doctors recommend... Diane .

Diane:

I hope you didn't infer from my post that I was criticizing your and Pete's decision for salvage surgery as I certainly did not mean to do that.  I think things have changed a lot in the last couple of years and it is because of problems like the ones that Pete has had that have led me to my decision about that not being an option for me.

I think it's very valuable and sobering that people here read about Pete's experience before choosing which procedure they have since that gives them close up knowledge about what can happen.

Best wishes,

Tudpock