Has brachytherapy worked for most all of you?

Andrew, thanks for that report.
I do have a question for you and since you and your brothers have a diverse set of treatments, how did the skill of the treating hysician come into play?

For example, with surgery, obviously the skill of the surgeon is very important in outcome and side effects, so essentially there could be a large margin of error. However with IMRT, you're essentially having techs do all the setup and positioning correct? So I'm assuming a low margin of error? With Brachy, is there a special skill-set sought after? Sounds like it's more involved then IMRT.

Squirm said...
Andrew, thanks for that report.
I do have a question for you and since you and your brothers have a diverse set of treatments, how did the skill of the treating hysician come into play?

For example, with surgery, obviously the skill of the surgeon is very important in outcome and side effects, so essentially there could be a large margin of error. However with IMRT, you're essentially having techs do all the setup and positioning correct? So I'm assuming a low margin of error? With Brachy, is there a special skill-set sought after? Sounds like it's more involved then IMRT.

For us the skill of the physician wasn't consideration for the type of treatment. The hospitals my brothers and I use all believe in a balanced approach and are basically non-profit HMOs. They don't make money on any specific treatment - the opposite is true, the make money by not treating. It was only after I selected my treatment that I consider who the doctor was going to be.

After my biopsy I was given an appointment at the cancer clinic with what they refer to as a "multidisciplinary team." At that appointment I got to speak to their best surgeon and RO plus I was assigned an RN who acted as my treatment coordinator. I was never pressured into any specific path. In fact it was the surgeon, who had an impressive resume, suggested that I might do better with radiation. Same happened with my brother who did the brachy.

My brother who did surgery is really of the mentality, "just cut the darn stuff out" and never really seriously considered radiation.

My IMRT was done in a first rate clinic with very skilled and caring doctors and technicians. The consideration for a IMRT clinic is really based on the skill of the RO to setup the program and skill of the technicians to make sure that they setup everything very carefully everyday.

With my brother on the brachy, we just got lucky. My brother is on Medicare so we figured we weren't going to get much choice but when we saw an RO who specialized in IMRT he suggested brachy might be better and that he knew a first rate doc (Dr. Kurtzman). The rest is history.

So I always say, don't select a treatment until you've explored each option and have had a couple of opinions.

And run away from any doctor trying to sell their brand of treatment.

Andrew

I'd say the side effects from brachytherapy are less than those of surgery in terms of recovery time, urinary control and of sexual potency. And yes, you still ejaculate (albeit at about 50% of pre-seeding levels).

I'm at about 10% (ejaculate) compared to pre treatment levels. I do take Cialis daily but I have never wet the bed or my pants and I've never had to stick a needle in my penis.

ed

I couldn't be happier with my brachy choice. I would recommend it to anyone who is deemed to be a good candidate.

Squirm said...
Andrew,
Thank you for the informative reply. First question, why did your RO believe brachy would be a better choice for your brother? Was there a specific criteria?

My brother has cerebral palsy. The spasticity of the disease makes it impossible for him to lie still for IMRT. The minimal invasive nature of brachy was perfect for him.

I would have gone that route too but under my health plan I would have had to travel to another city and wouldn't have gotten the choice of doctor I wanted.

Andrew

Squirm said...
Andrew,
Third question to both or anyone, is there two different versions of brachy therapy? High dose, low dose? Advantages/disadvantages? Was there discussions on which is best in your case?

I asked the RO about HDR vs LDR and as he explained it with the advent of the stranded seeds it allows him much more flexibility in the placement of the seeds with a higher dosage. He no longer does the HDR procedure. This was just my experience.