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Has brachytherapy worked for most all of you?

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Posted 2/19/2014 2:24 AM (GMT 0)
Seems like most guys here have had good luck with brachytherapy. I'm interested in knowing if anyone went into brachytherapy hoping they would be cured but regretfully........weren't!
I had RALP 5 weeks ago. I'm happy with my decision. I'm trying to help another guy in our situation and would like to hear the bad part of making what anyone now has determined to be the, wrong decision. I understand this might be a touchy situation, so pardon me if this offends anyone but I think this could be of help!
Thanks
Posted 2/19/2014 2:48 AM (GMT 0)
if you use good doctors i don't think you can go wrong. both treatments work equally well. i think because radiation oncs are more selective you see fewer failures -- e.g., you don't see G9s getting seeds as a stand alone treatment.

you do see plenty of guys needing salvage radiation after surgery because if you insist and even if you don't the surgeons will operate on anybody.

then there's the ole side effects. a subpar surgeon or a good one having a bad day can ruin your life pretty easily. so there's no wrong choice, per se (or per say as purg would say) :-) .

ed
Posted 2/19/2014 2:50 AM (GMT 0)
No problems here. Procedure was about 1 hour and was able to do anything I wanted the next day. 5 years and no ED, never used any meds. Psa went from 40 to .1.
What can I say other than I' m totally pleased and would recommend this option to anyone, especially after reading posts on this board and others of patients dealing with the side effects of surgery.
Posted 2/19/2014 2:59 AM (GMT 0)
New to it but no problems so far (happy to report).
Posted 2/19/2014 1:18 PM (GMT 0)
I'm very pleased with brachytherapy. I used the High Dose rate version, not the seeds.

What I am most pleased with is that I have an objective excellent urologist/surgeon who recognized that I was not a candidate for surgery due to my high risk dx based on my biopsy and high PSA. He flatly stated he would not operate on me.
Posted 2/19/2014 1:30 PM (GMT 0)
I'm going on six years with cure and no SE's. Feel free to copy and paste my long winded journey in my signature.

In the years I have been here I do know of a rare failure. Perhaps the poster will chime in. This was an unfortunate case where the patient not only had a failed brachy but then chose salvage surgery which led to a whole host of other problems.

If you look at the overall statistics, you will find that the cure rate with brachy seems to be roughly equivalent to that of surgery but with (on average) fewer onerous SE's.

Jim
Posted 2/19/2014 2:55 PM (GMT 0)
I don't understand the logic if surgery "fails", they say you can then do radiation. If that is the case, wouldn't radiation have been beneficial as the primary treatment then?
Posted 2/19/2014 3:47 PM (GMT 0)
Hello ......

   Yes - I did have brachytherapy after external radiation - and the brachytherapy was done by a highly-thought of doctor in Westmont, Illinois. The combination was successful - at least for close to 6-years, before the cancer returned - and then spread or metastiszed to the kidneys, ribs, adrenal glands, liver and lymph node.

   My understanding is that the cancer metastisized return is not a high percentage - but the chance does exist. Please see my signature below.

   Note - my current chemo has however reduced my PSA from an 83.09 down to a 15.49 over a 19-week timeframe.

Peace and wellness

Rob & Gizmo

 

Posted 2/19/2014 4:50 PM (GMT 0)
You need to be careful in defining treatment reoccurrence. Reoccurrence can be local or systemic. Brachy has about a 1% local reoccurrance rate and about 30% of the reoccurrence from surgery are local. (the cure rate for those undergoing salvage radiation)
Systemic reoccurrance for both treatments are much higher as systemic disease cannot be treated by either surgery or radiation. Only a local reoccurrance can be treated by a salvage treatment.

The last poster had a systemic reoccurrance which would not have been cured by any treatment option
Posted 2/19/2014 5:58 PM (GMT 0)
So far so good.....


1. Radio active seed implant (low dose radiation) a stand alone
treatment and

2. High Dose Radiation (HDR) in combination with External Beam Radiation
for 5 weeks (which is what you received).

What was placed while you were under anaesthesia was hallow straws
(about 20) which were then used to administer a boost of HDR to the
prostate gland. You also had 3 gold markers placed in the prostate which
were then used as a guide for the external radiation part of your
treatment. The gold markers are not radioactive and will remain in the
prostate gland even after treatment. If you want to read info. with
regards to the treatment you received, read on HDR Brachytherapy in
combination with External Beam Radiation Therapy.
Posted 2/19/2014 6:49 PM (GMT 0)
Squirm, yes. That is why more men are using radiation as a primary treatment. As the IMRT/IGRT and Proton methods have vastly improved delivery in the past 10 years radiation is now as effective or more so in intermediate and advanced cases than surgery with generlly lessened side effects. In many low risk cases each treatment appears to be equal in cancer control. However, in the intermediate and advanced high risk cases where there is a decent probability of having SRT it appears that the best course is radiation instead of surgery.
Posted 2/19/2014 7:00 PM (GMT 0)

Squirm said...
I don't understand the logic if surgery "fails", they say you can then do radiation. If that is the case, wouldn't radiation have been beneficial as the primary treatment then?

No treatment can guarantee 100% cure rates -- not surgery and not radiation. Perhaps the problem comes from the 20-30% of biopsy clinical reports that are incorrect -- a biopsy can easily miss a more aggressive tumor that the medical team was not aware of prior to the surgery.

Maybe someday, if they have new tests that can tell, with 100% accuracy, the exact nature of the cancer within the prostate, treatment options can be offered with more foresight and less hindsight.

Until then, doctors and patients can only do what seems to be the right thing at the time.
Posted 2/19/2014 9:11 PM (GMT 0)
Squirm,

It occurs to me that I don't know much about you. I don't remember your ever talking about yourself much. What is your personal experience with treatments? You've been a member here for six years -- lots longer than I have. You always ask a lot of questions; have you formed any opinions of your own?

Just curious.
Posted 2/19/2014 9:28 PM (GMT 0)
not so sure about radiation being better than surgery in intermediate cases. The oncologists I spoke to certainly did not make that point.

I suppose it can make more sense in advanced cases since you'll need it anyway. But even in those there are plenty of men who select surgery as well knowing they will move on to radiation. Many of these have stated there reasons for doing so here.
Posted 2/19/2014 9:40 PM (GMT 0)
Davidg, good points. While I can quote Dr. Scholz' book showing brachytherapy cure rates for intermediate patients at 85% vs. 70% for surgery patients, I can also find other sources and nonograms that would dispute that. I usually feel my safest statement is that the cure rates are comparable because, honestly, the studies and stats disagree.

Jim
Posted 2/19/2014 9:43 PM (GMT 0)
As I posted in a thread about my brother, I only know of good experiences with brachy. I have to admit that there are times I wish I would have explored that option more fully before I did beam radiation.

I don't know any of the studies or sats on using radiation as a primary treatment for G7 cases but in my family, one brother had surgery, one had brachy and I did IMRT and we all are doing well and show no sign of re-occurrence so I just say, pick your poison and take your best shot as they all seem to work.

Andrew
Posted 2/19/2014 9:44 PM (GMT 0)
Sure, but not all surgeons and all radiologists have the same cure rates as the national average. 70% cure rates do not represent the numbers of many surgeons. There are some with cure rates in the mid 80s. Skill plays a roll as does disease level and other factors. I think these factors need to be discussed.
Posted 2/19/2014 9:48 PM (GMT 0)
nm
Posted 2/19/2014 9:52 PM (GMT 0)
I would stick with radiation only personally, but they've given their reasons here (advanced case guys) for also wanting surgery and I honestly don't think it was because they didn't give their situation serious thought or because they were mislead.

I also know surgeons who routinely tell G8s and higher that radiation would work better for them if they believe it has already escaped the capsule.
Posted 2/19/2014 9:54 PM (GMT 0)
Squirm,
The primary reason for local failures in surgery is not all of the cancer being removed, especially around the nerve bundles. There is always some prostate tissue remaining after surgery and if those contain cancer cells they will continue to grow. The other reason is extra capsular extensions, especially in the apex. On average, the rates of ECE are around 20%. They range from 11% for the best surgeons to 35% for the less experienced ones.
These issues are resolved when using radiation as it throughly kills cancer around the nerve bundles and both the nerves and uretha's cells are less affected or damaged by radiation. Radiation also treats a margin of up to 15mm into the prostate bed eliminating ECE reoccurrance. These are the main reasons that radiation has a higher cure rate. and the only reason salvage radiation is effective in local reoccurrance are primarily due to these reasons.
An MRI or CDU can identify tumor location and if the tumor is not near the nerves or shows to be fully contained with no ECE or tumors in the Apex then surgery should be successful. If any of these conditions exist then radiation should be the treatment of choice.
Posted 2/19/2014 10:31 PM (GMT 0)
nm - no mas ? :)
Posted 2/19/2014 11:53 PM (GMT 0)
no I didn't express myself clearly and I had to leave to I axed the message. in a nutshell, I think a lot of guys that surgery won't "cure" are not properly counseled. they just want it out and the doctor tells them there is no back up for radiation and its a done deal.

they show up here all the time with a rising PSA and not sure what to do. many of these guys miss the optimum window for SRT. the questions they ask here should have been answered BEFORE surgery especially if there was a good chance via the tables that follow-up radiation would also be needed.

we went to my consultation just wanting the cancer out. my uro does open surgery and his partner robotic. my doctor told me he could not in good conscience recommend surgery because I had a 60% that the cancer had escaped the capsule. he told me about the possible SEs once the target has been surgically removed and he said he had never had a patient with my numbers whose cancer had returned that had received combination treatment.

and that's what we did.

ed
Posted 2/20/2014 12:05 AM (GMT 0)
F8 I have to agree with that. Frankly, one of my local doctors seemed to be in quite a hurry to start cutting. I had a lot of questions and he were pushing surgery big time. It did not set me at ease. I wondered if they had a robot to pay off or something...

The hospital had done no LDR brachytherapy and done only 20 HDR brachytherapy (the two I was interested in).

Thankfully I had found this forum and people who had been through it to give their knowledge and support.
Posted 2/20/2014 4:32 AM (GMT 0)

InTheShop said...
As I posted in a thread about my brother, I only know of good experiences with brachy. I have to admit that there are times I wish I would have explored that option more fully before I did beam radiation.

I don't know any of the studies or sats on using radiation as a primary treatment for G7 cases but in my family, one brother had surgery, one had brachy and I did IMRT and we all are doing well and show no sign of re-occurrence so I just say, pick your poison and take your best shot as they all seem to work.

Andrew

Andrew, they may have similar cure rates given a specific tumor aggression but what about side effects. If you have less side effects from radiation vs surgery that could turn it in someone's favor. If they're already looking at radiation, they might concur that brachy or proton has less side effects than IMRT.

I'm assuming age might play a role too. Is it true that the old adage of radiation for older age and surgery for younger age is going away?
Posted 2/20/2014 5:24 AM (GMT 0)
Squirm - age didn't play much of a part in the choices I and my brothers made. In fact, none of our doctors really considered age at all. They looked at the biopsy report and our general health. All three of us were told that either surgery or radiation would be curative in our cases (we're all G7). In fact our doctors insisted that we each make the rounds of all the available options before deciding. I was 52 at DX, none of my docs -surgeon or RO - was a bit worried that IMRT would cause me any problems 20 years from now.

As far as SE, the brother that did brachy seems to have the least. Me, the IMRT and my 'surgery' brother seem to have about the same level of SEs but not much in either case. We each have a bit of urgency issues and some mild ED. My hemorrhoids are a bit worse but over all, I came out of this without much in the way of long term problems - at least so far nothing a few pills and watching my health more carefully haven't been able to take care of.

I've been very happy that I skipped surgery and went the radiation route. Like, I've said, I don't know the stats but it seems to me that are a lot of guys that would do just fine with brachy - it's a simple outpatient procedure, half a day (spent more time driving my brother there and back than in the procedure), few side effects and for localized PC does the job just fine. Not for everybody but I think more could benefit from it.

Andrew

Andrew
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