HDR Brachytherapy 15 months...

Congrats, Dewayne.

And encouraging to me. I'm approaching my one year HDR anniversary and my 9 month PSA had bounced. Hoping for a drop at my next test like you've had.

brava said...
thanks for posting. I'm thinking about getting brachytherapy too. what were the factors that led you to a brachytherapy hdr decision as opposed to other treatmentts? how did you handle the risk of secondary cancers?

Appreciate your thoughts

Basically I found the cure rates were the same for surgery, LDR and HDR. I've been 'off the grid', so to speak, in all my studying about PCa, but I did a lot of research and felt it was as good or better than ANY treatment.

With that knowledge, I chose the easiest path with least chance of side effects. Surgery works great for some, but I found the chance for error higher with that option.

I've never seen evidence of risk of secondary cancers from HDR. Tall Allen or some of the others could address that better than I.

Though I still drop in here often, I haven't maintained the same focus or interest in the subject since I've been 'cured'.

You owe it to yourself to go somewhere where you can hear about all of your options. I spent a day at Duke speaking to three specialists and then visited the RO at Winship.

Dewayne said...
I've never seen evidence of risk of secondary cancers from HDR.

All radiotherapy for prostate cancer is associated with a modest increase in secondary cancers. I have seen studies that report that approximately one in 70 patients undergoing radiation and surviving more than 10 yr will develop secondary cancer. The most common sites for secondary cancers are bladder and rectum. Obviously these studies show the outcome for men treated more than 10 years ago and is not valid for men treated with the more evolved procedures of today. All these studies are outdated when published. But I don't believe the risk is negligible if you plan to live another 30 - 40 years so I didn't personally chose radiation.

Dewayne, that is great news indeed. I wish you many more years of similar success.

Re the question of secondary cancers, shown below is something I posted last year that I still believe to be true:

Jim

I understand that the fear of long term radiation damage is palpable for many folks. However, the facts don't necessarily support that conclusion. For anyone who is interested, you can read this paper from 2012 written by a multi-disciplinary team from Sloan Kettering. onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2012.11385.x/full

This is purported to be the first report in the literature to compare the incidence at a single institution of SM's (secondary malignancies) in patients treated with EBRT or BT, with a control cohort of patients contemporaneously treated with RP. The EBRT was the newer type, i.e highly conformal-based treatment such as intensity-modulated radiotherapy (IMRT) instead of the "old type" EBRT that was used 20 years ago.

The bottom line is that "the 10-year likelihoods for bladder or colorectal cancer SM development in the RP, BT and EBRT groups were 3%, 2% and 4%, respectively." In other words, the differences were negligible between the treatments -- including surgery.

Given that this was done within one institution, the argument that "someone else sees the problems" is bogus.

As we seek to educate new HW members about choices, I prefer to emphasize the major issues rather than those at the end of the curve like future secondary cancers from radiation or dying on the table during prostate surgery. Both can happen; neither happens very often.

I prefer facts over fear, actual data over anecdotes, experience over enthusiasm and Metropolis over Mayberry. But, hey, that's just me. Of course everyone is entitled to their own opinion.

The % of needing SRT after surgery is highly dependent on your diagnosis. For example, if you've been staged T3, the percentage would be quite high. In your case, as a low volume G7, the odds of needing SRT would be pretty low (assuming no signs showing of any spread). In other words, you have a pretty good chance of being cured with any treatment you choose.

The questions you're asking about SEs are good...but I'd focus on the SEs of the primary treatment since you're unlikely to need a secondary treatment.

brava said...
One questions that I would like someone to please answer is what is the percentage of men who undergo RP and still need radiation therapy at some point as follow-up for the PC treatment. I must weigh this in to whether or not to go "Brachy"or RP. As I see it, if this number is more than 51% (choose this arbitrarily), worrying about secondary cancers is something that I am likely to do anyway with RP or Brachy. Might as well save some of the nerves and the possibility of a woody. I know I'm probably missing a few things here but it's part of the learning process.

Brava,

As others have already said, the answer is unique to your diagnosis and stats. I used the Partin tables to help with my treatment decision with regard to your concern. Click here to go to the Partin tables, plug in your data, and you can see the statistical likelihood of organ confined PCa, EPE, SV+ and LN+. Plugging in this data for my Dx, I had an 80% chance of organ confined PCa for low risk (as opposed to very low risk) PCa Dx. I therefore chose a targeted HDR-BT treatment with hopes of minimal SE's long term, despite my young age. I'm only a few weeks out from primary treatment so time will tell.