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Posted 11/15/2014 4:20 PM (GMT 0)
I'm interested in hearing from guys who had Brachy as their initial treatment
What was your overall experience?
What were your side effects
How far out are you and how are you doing in terms of success of the treatment
Why did you decide to do Brachy and do you have any regrets?
And if you are ok with it, what was your initial Gleason and your age, at diagnosis?

I know I'm asking a lot of questions, thanks in advance.
Posted 11/15/2014 4:54 PM (GMT 0)
My older brother had brachy (I am his primary caregiver). His numbers were slightly worse than yours (G7, PSA 11.2, age 63) He has cerebral palsy and was not candidate for surgery. We went to a couple of ROs, the first ruled out beam radiation as he'd not be able to lay still (spastic muscles) and he'd not be able to tolerate the six week routine. The brachy guy was positive and we ended up selecting that.

It was the perfect choice for him. The procedure was done in the morning and we had him home by lunch time. The side effects were some rectal bleeding and blood in the urine. He passed blood clots for a week or so. He was incontinent before the procedure and gain a slight bit of control after (URO thinks a tumor was pressing on something.) He had a cath for 2 days after the procedure.

18 months later, his PSA is down to 1.1 (constantly dropping) and he has no other side effects from the procedure. He is extremely happy that he had the Brachy treatment and his medical team is impressed with the result.

After seeing how well he did, I wish I had done brachy instead of my IGRT beam stuff. It's a great choice for guys on the low to intermediate risk side of the scale.

Andrew
Posted 11/15/2014 5:11 PM (GMT 0)
You have mail turn
Posted 11/15/2014 5:17 PM (GMT 0)
If my bone scan comes back clear then I will be seriously looking in that direction, because I think it would work best for me. With surgery I don’t think a spell in hospital and the recuperation period after would work living on my own. Dont rule it out. With your numbers I think it would work well. And you get to keep your walnut and wet dreams. yeah
Posted 11/15/2014 5:27 PM (GMT 0)
Casper, the stay in the hospital is 2 days. I did it on my own without any problems at all, don't let that be a deciding factor. Just plan ahead, you'll find a thread here listing some hints from the boys.
Cheers, Doug
Posted 11/15/2014 5:53 PM (GMT 0)
I had brachy as my primary treatment supercharged by IGRT and HT. imo, brachy would be my #1 choice of treatment if qualified.

ed
Posted 11/15/2014 6:09 PM (GMT 0)

Shaba.Doug said...
Casper, the stay in the hospital is 2 days. I did it on my own without any problems at all, don't let that be a deciding factor. Just plan ahead, you'll find a thread here listing some hints from the boys.
Cheers, Doug


Thanks Doug. I was told over here that it could be up to 7 days! Either way I am leaving all options open until my MDT meeting on the 25th.
Posted 11/15/2014 6:42 PM (GMT 0)
I had Brachy, IMRT combo for a G 4+3 and psa of 40.
My main reason for the choice is with tumors in the apex and nerve involvement surgery was a poor option with a high probability of positive margin, ED, and incontinance.
Besides the lower probability of side effects and the short recovery time, a couple of hours, the cure rates for high risk patients was higher than surgery.
Posted 11/15/2014 6:43 PM (GMT 0)
Prato, when i joined HW six years ago I became one of very few men here who chose brachytherapy. Since then there have been many, including an increasing number who choose HDR Brachy (I chose LDR). Several of these guys (and ladies) are still active so hopefully they will weigh in on your questions.

My specific answers are:

1. What was your overall experience?

I am extremely satisfied. The procedure was minimally invasive and I was back to normal activities within a couple of days. In a nutshell, my docs consider me cured and I have no SE's except reduced ejaculate. Everything else works exactly the same as before my procedure. If you want to read a long winded summary of my journey feel free to copy and past the link in my signature.

2. What were your side effects?

Early SE's included some frequency and urgency of urination. Those were easily controlled with Flomax and lasted about three months. I had zero sexual side effects except for reduced ejaculate. I don't need pills or any other aids for sexual activities even though I am now 68 years old.

3. How far out are you and how are you doing in terms of success of the treatment?

My treatment was six years ago. I'm doing great per the above.

4. Why did you decide to do Brachy and do you have any regrets?

I did a TON of research including consulting with multiple doctors in multiple disciplines and reading multiple books and dozens (hundreds?) of studies. I am pretty much a data driven guy and generally facts drive my decision process. I learned that Brachy provided equal cure rates to surgery with a very small chance of lasting urinary SE's and a much better chance of retaining my sexual potency. Brachy was also a much simpler operation (out patient) with very little recovery time. I had no "get it out" issues; what I had were "get it cured" issues and "low SE" issues. The facts overwhelmed me and ultimately made the decision fairly obvious to me. No regrets.

5. And if you are ok with it, what was your initial Gleason and your age, at diagnosis?

I was 62, G7 (3 + 4) in excellent physical health and with a satisfactory urinary symptoms score that support a brachy decision.

Hope this is helpful.

Jim
Posted 11/15/2014 6:54 PM (GMT 0)
Casper, that 7 day stay is likely based on having open surgery as opposed to laparascopic (keyhole) whether Robotic or not. Laparascopic is less invasive hense only a 2 day stay.

FWIW and based purely on anecdotal evidence of guys I know personally, the resultant side effects are far better with open vs Laparascopic. Others may will disagree.

Chas
Posted 11/15/2014 7:20 PM (GMT 0)
Thanks to all especially you T-Jim.
I hope I can hear from others as well.
Jim, did you not have any side effects in terms of Bowel problems, diarrhea etc? I've read that that's an issue with Brachy
Posted 11/15/2014 7:42 PM (GMT 0)
I had HDR brachy as my main therapy, in conjunction with five weeks of IMRT and HT. Clearly, any brachy you would have would (LDR or HDR) would be a mono-therapy instead of the multiples like I had.

I had two sessions and the overall experience was only marred by having to have the catheter re-insterted after the first session. For the first few days I had to pee a lot and it burned somewhat, but that quickly went away. I had to be careful sitting for about the first month. The SEs from HT were far worse than anything from brachy.

I'm coming up on two years with no major side effects--everything works the way it used to, with the exception of dry ejaculations. I'm also doing well PSA-wise, although it's way too early to declare success since I've only been off HT for about six months.
Posted 11/15/2014 7:46 PM (GMT 0)
My brother had no bowel issues with brachy.

I on the other hand have had my hemorrhoids aggravated by the IGRT and they are much worse than before.

Andrew
Posted 11/15/2014 8:10 PM (GMT 0)

Chask said...
Casper, that 7 day stay is likely based on having open surgery as opposed to laparascopic (keyhole) whether Robotic or not. Laparascopic is less invasive hense only a 2 day stay.

FWIW and based purely on anecdotal evidence of guys I know personally, the resultant side effects are far better with open vs Laparascopic. Others may will disagree.

Chas


Thanks Chas. I am not sure what system they use at my new hospital, so will have to wait until my visit on the 25th, but I am still leaving all options open. The results of my bone scan may be the deciding factor for me.
Posted 11/15/2014 8:34 PM (GMT 0)
Pratoman:
Overall experience/SEs: Very fortunate to be treated by Dr. Peter Grimm who pioneered "stranded" seeds which are way less likely to migrate. In the hospital and out a few hours later with some burning pees that were a little red. A few hours post-op nausea and ready for a light supper. Resumed waking routine later that day. Bruising for a few weeks with a feeling of bowl movement after urination that was easily relieved with a good walk. Ejaculation now back to 75% and expecting more when I am completely free of Flomax. No Ed with slight urgency after fishing for five hours in the boat.

My signature has the stats you are looking for and I have no regrets with LDR monothearpy. My final decision was based on the guiding hands of the HW brothers on this forum with some superior guidance and personal help by A Yooper!

http://prostate-cancer.org/PDFs/Is14-2_p3-11.pdf
Posted 11/15/2014 8:38 PM (GMT 0)
Prato, no. No bowel effects. That does happen in a small percentage of the cases but not to me.

Jim

P.S. BTW, you didn't ask it on this thread but did bring up the question about salvage therapy on another thread. That is the old chestnut that if you have surgery first you can get salvage radiation afterwards but if you have radiation first you cannot then have salvage surgery. This is only PART of the story. The truth is that salvage surgery after radiation IS problematical but...there are many other options for salvage treatments after radiation that are just as effective as salvage radiation after surgery. So -- this is not a good reason to pick one treatment over another.
IMHO, one should focus on the main issues around treatments and those are cure, urinary SE's and sexual SE's. Things like salvage options, bowel issues and dying on the table during surgery are items that crop up on the edges of the curve. Focus on the trifecta.
Posted 11/15/2014 9:17 PM (GMT 0)
A Yooper is the man to talk to. He did a lot of research before he chose Brachy.

Casper555,
I don't miss the walnut or the wet dreams. Much less mess and no cancerous walnut in my body. yeah

Bill from Florida cool
Posted 11/15/2014 10:05 PM (GMT 0)
My overall experience with the HDR brachy treatment was good. Everything went as was described to me ahead of time.

I'm only 5 weeks out from finishing my treatment, SEs as follows:

Rectal SEs: 1 st week - feeling of "fullness", 3 to 4 bowel movements per day, no diarrhea. Dr. explained that these SEs were due to physical aspects of treatment, not the radiation (TRUS in rectum during implant). All back to normal after 1st week.

Urinary SEs: Frequent nighttime urination, some nights once every hour or 2 during the first 2 weeks. Blood in urine for 1st week. Occasional urgency. Getting better now, but not back to pre-treatment level (yet).

Sexual SEs: No erections for first 3 weeks, now back to 70% of pre-treatment function. Hope will continue to improve. Still have blood in ejaculate and reduced volume. Dry orgasms are a possibility in the future.

Physical SEs: Pain in implant area for first 2 weeks, especially when sitting down. Almost back to normal now. My job is very physical, I returned to work 4 days after completing treatment, and was able to perform normally. I started walking right after treatment, and resumed weight lifting 2 weeks after treatment.

My first post treatment PSA test will be in January, so that will be the first indication of how successful this was.

No regrets on my decision.

I chose brachy because I did not want surgery due to the risks of ending up "limp and leaking". I picked HDR over permanent seeds since HDR can deliver the radiation more precisely, and also effectively treats a 5 mm margin outside the prostate with very little damage to normal tissue. With permanent seeds, the seeds can migrate once implanted, and I also didn't like the idea of the seeds being in my body forever.

A few resources that helped me decide:

Presentation at 2012 PCRI conference by John Blasko comparing 5 year cure rates and long term side effects of different treatments:

Part A: vimeo.com/60923180

Part B: vimeo.com/61449619

UCLA HDR brachy web site: radonc.ucla.edu/site.cfm?id=443

My original GS was 3 + 4 and I was 53 y.o. when I was Dx'ed
Posted 11/15/2014 10:20 PM (GMT 0)
I wish I had, had Brachy, seattle prostate center right down the road from where my walnut was plucked, one of the top experts. I knew nothing about the disease and for whatever reason a gl 6 was considered intermediate risk in Oct of 2009. I have no regrets , just a wish, as I got "lucky" and the cancer was classified as a gl 9 by the U of W. Made the surgery an arguably better choice in hind sight. BT probably would put me in same position as today with out any ED. I was continent fro cath removal, but took 2.5 years for stuffabll potency. Excellent pathology, excluding gleason upgrade. Some one on another thread used the term upgrade for for your actually downgrade of gl score. I get his " new " meaning but it is confusing to newbies and others, however clever for him. I suppose we should call cancer that has been discovered over the margin cut, a negative margin and one that does not, a positive margin. You had a gleason downgrade from 3+5 to 3+3 . Before others want to get "too clever", lets just stick to standard phraseology. Moderators, take note please. PS Standard phraseology is an air traffic control term. Imagine what can happen if that was cleverized. In the trade its called aluminum showers, macabre, but true.
Posted 11/15/2014 11:02 PM (GMT 0)
I see that it was a longterm vet that made the mistake on nomenclature. He is much too clever for that to be anything other than a oversight, mixup, snafu, blah ,blah so disregard my last.
Posted 11/15/2014 11:35 PM (GMT 0)
Hawaii-Guy,
I jus spent an hour watching the two videos. For sure it gave me pause. With that said, I looked up Blasko, the doc giving the presentation, which was clearly pointing towards Radiation therapy vs surgery. And surprise, he is a radiologist. In addition, I looked up Grimm, who is the one who did the study that was a compilation of hundreds of previous studies (and got the original report from Yooper) that the presentation was based on. Surprise again, his focus is Brachy.

So its hard to know what to make of all this. I wish I could find a surgeon who would tell me Brachy is my best option, or an RO who would tell me that Surgery is my best option. Then it would solve my problem.
Everyone has a bias, maybe not a purposeful agenda, but a bias, one which sometimes, they themselves don't realize. Even studies funded by NCI or NIH, are conducted by doctors who I assume specialize in one thing or another.

Edit: one more thing - not sure of the dates of these studies, but a 5 or 10 year study, by definition, would be a population of men who were diagnosed at least 5 or 10 years ago. I think that men diagnosed today, will have a much better prognosis with certain therapies, for example (yes, I have a bias too) Robotic, in which Drs have become much more proficient. And I would think the numbers would be even better if you isolated those guys who are lucky enough to have the surgery done by the elite drs, who have done 3-4-5000 of these surgeries. Add Parametric 3T MRI into the mix, and I bet its even better.

My head is F'n exploding from looking at data, research, the forum, etc pretty much every waking hour that I am not working. I need a rest but cant tear myself away from it.

Post Edited (Pratoman) : 11/15/2014 4:39:28 PM (GMT-7)

Posted 11/15/2014 11:45 PM (GMT 0)
One more thing - ok, I am G6. I cant get past the fact that I don't know if I am really G6, doing the surgery. What if there is G9 in there that was missed, and my odds with Brachy alone aren't as good as they appear.
Posted 11/16/2014 12:40 AM (GMT 0)

Pratoman said...
One more thing - ok, I am G6. I cant get past the fact that I don't know if I am really G6, doing the surgery. What if there is G9 in there that was missed, and my odds with Brachy alone aren't as good as they appear.

That would only matter if the G9 was outside the prostate bed. If it's in the prostate, the radiation will zap it right along with all the nasty G6s too.

This is the risk of all treatments directly on the prostate - you get everything that was in the prostate, of any score. If you had a G9 outside the prostate bed, the surgery, IGRT or branchy will miss it and you're on to HT. The gleaseson score in the prostate doesn't matter that much. What matters is it contained.
Posted 11/16/2014 12:48 AM (GMT 0)
Plus BT has the capability for close surround ing areas of prostate………….. Your going for the OLD gold standard, I just know it. betcha betcha betcha….. Week be for Christmas right. You will be fine, it fits your personality, but is not the best choice. see caveat in signature below. oh reference experience. The captain of the Titanic had 30 years of experience working against him. See you ain't gonna get perfection in this paradigm. when you make the call turn the corner on it and trust your practitioner. anybody ever wonder why medicine and law are called practices.
Posted 11/16/2014 12:48 AM (GMT 0)
Prato,

The ONLY unbiased doctor will be your PCP, and respectfully speaking, he doesn't have enough knowledge about either procedure to make a recommendation.

I'd recommend searching this forum for all the recent comments from those who've had surgery and brachytherapy. You'll find a LOT more suffering, SE's, etc, from the surgeries BUT there's more unknowns as far as the future SE's related to brachytherapy treatment.

My radiation oncologist told me straight up both options would be great for me and even said the surgeon I had consulted with was very, very good. I'm planning for the HDr brachytherapy on Dec. 2.
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