Important questions to ask your **Brachy** doc

These lists of questions have been compiled previously. Perhaps someone who has the time and expertise could provide a link or reference...?

Jim

Following is a list of questions I used:

How many of these procedures have you done?

How do you compare this for my situation vs. surgery?

How do you compare this for my situation vs. HDR brachytherapy?

For my situation, do you recommend LDR brachytherapy as a monotherapy or with other radiation treatment?

What is your success rate for this therapy in treating prostate cancer, not having recurrence?

Will you be using CT scans or conventional X-ray scans for alignment purposes? (The following is from American Brachytherapy Society: The real time intraoperative adaptive approach to brachytherapy offers a great improvement over preplanned treatment. Fewer seeds are needed to produce the same total; this offers a smaller radiation dose with fewer side effects.)

What method and radiation machine will you be using?

Explain the procedure…pre op, op and post op.

The seeds:
Some of the literature suggests using MRI to insert the seeds. Is that your technique and, if not, why not?

How many seeds and what type?

Have you had any issues with seed migration?

Could you give me a general idea of how the seeds are plotted? How many in each section, etc?

What are the pro’s and con’s of stranded seeds?

What is the life of the seeds? Time release ? – please explain.

Do the seeds affect other organs?

What is the timeline…pre op, op and post op?

If I decided this week, when would we start?

What are the side effects for your patients? (Continency, ED, Bowel – and explain for example what “fully continent” means.)

What are your percentages for each?

How about these side effects over time, i.e. quality of life 2-3, 5-10, 15+ years out?

Re the urinary side effects, how effective are the drugs to control them? (Flomax, Rapaflo)

Re the ED side effects, how effective are the drugs to control them? (Cialis, Viagra, Levitra)

Re the bowel side effects, how effective are the drugs to control them?

When would you want to do the first post-radiation PSA test, and what would you expect for results. .

When will I be able to continue my normal activities? .
When can I go back to exercising? (Aerobic, weight training?)

How soon can I go back to work?

How soon can I resume sexual activity?

Do I need a special diet during or after my treatment?

Will this cure the cancer?

What do you see as the advantages of this vs. surgery?

If I have this process and the cancer returns what happens?

Is surgery still possible in the future? If not, what salvage treatments are available?


I'm sure others will add to this as well. Continued best wishes to you as you move down this segment of your journey.

Here is what I have so far. Anyone else want to add to the list?
(Note: My first meeting with the brachy doc is tomorrow morning.)

Outcomes

• Will brachytherapy cure the cancer?
  
• How many patients have you treated who are my age?
  
• What is your success rate for this therapy in treating prostate cancer, not having recurrence?
  
• What are the side-effects of your patients that are my age? What does “fully continent” mean? How effective are the drugs to control the side effects?
  
• How about these side effects over time, i.e. quality of life 2-3, 5-10, 15+ years out?
  
• How would you advise me to decide between LARP and Brachy? Which one do you think is likely to have the better overall outcome?

Technique

• Low-dose permanent or high-dose temporary?
  
• How many seeds and what type?
  
• How do you determine the placement of the seeds? CT scans, MRI, conventional X-ray, other?
  
• How do you prevent seed migration?
  
• Would brachytherapy be sufficient, or need to be in conjunction with other radiation treatment?
  
• Would you use stranded seeds? What are the pro’s and con’s of that?
  
• Do the seeds affect other organs?

Procedure & Follow-up

• Explain the procedure…pre op, op and post op.
  
• If I decided this week, when would we start?
  
• When would you want to do the first post-radiation PSA test, and what would you expect for results?
  
• When will I be able to continue my normal activities?
  
• When can I go back to exercising (and what type)? Work? Sexual activity?
  
• What tests/monitoring will be necessary to track whether the cancer returns (in the prostate or elsewhere nearby)?
  
• If I have this process and the cancer returns what happens?
  
• Is surgery still possible in the future? If not, what salvage treatments are available?
  
• What can I be doing today to prepare my body for the procedure (kegel exercises, etc)?

Thanks,

Gedaliah

gedman - once again kudos to you for doing your due-diligence to the level that you are. As I've said before, with a decision this big and important, to do anything less would just simply be a mistake.

Looks like you've got a great / comprehensive list there. Good luck tomorrow, and please give us your impressions of how things went.

Best to you.