Urine flow and post void test may derail Brachytherapy

I didn't have to get that kind of testing for IMRT. I've not heard many here talking about getting that test.

Not sure what's up with that.

Andrew

As I've mentioned before, my RO's main concern with the brachy-boost plus IMRT concept was exactly in that area, specifically the increased risk of urinary strictures. Vanderbilt's Cancer Center didn't recommend the "triple play" concept for exactly that risk. Vanderbilt's a regional referral center for men dealing with such side effects, so they are understandably cautious.

I'm not surprised at all they're checking you for that, and I would tend to err on the side of caution. Many (most?) seem to do fine with it, but it is a known risk.

Hi Mark, I am 5 months past HDRBT and a couple of months past IMRT. I was taking Flomax daily until about a week ago. Now I take one every other day as I still have some pushing required so I know there is still some swelling inside. A test at my MO's office last month showed I am voiding well - done by a simple ultrasound after I went. My RO gave me a timeline of being "fairly back to normal" after September. I guess I will wait to see what that is. Like others, probably at the 80% range. Good luck with your treatments. -JR

You raise a good point. Standard IMRT without brachy is (I believe) seven weeks versus five weeks as a combo therapy. Besides the length of the treatment, I don't know if it alters the radiation plan as well.

I had DART, similar to IMRT, brachy and ADT, treatment

I had to have a green light laser procedure after IMRT prior to brachy due to a growth blocking the urethra,or seed implant would not have been possible. Just a trim to open the pipe.

My RO was overseeing the whole thing, went well and allowed me to complete treatment.

So if your restriction is due to a similar condition, it may be an option for you

Newton..I'm scheduled for LDRBRT. What you are saying is I'd get just as aggressive RT by adding EBRT 45 gy to the IMRT I'm already scheduled for. Would it lengthen the number of weeks for the treatment?

Redwing 57 had 50.4 Gy pelvic nodes, 79.2 Gy prostate. He had the same urinary concerns and so passed on Brachy.

My local RO stated at our first consult back in July that she would not do the Brachy and just treat it with EBRT. At that time I was convinced I was going to have the "triple play" so really didn't trust what she was saying. now I'm beginning to think maybe she was on the right course.

For a month now ,I was set on HT+IMRT+Brachy. Things might be changing. Thank you for your input, I hope I could get more to responds but you,all the others have been very helpful. Thanks Mark

The dosing plan isn't that simple. Our forum's study specialist, Tall Allen, probably will chime in on this. There are interactions between BT dose, EBRT dose, and even dose rate of EBRT (like SBRT).

The current standard EBRT dose to the prostate, with IMRT and good conformance to the treatment area, seems to be around 79.2 Gy. I see that number a lot. Mine was 44 fractions of 1.8 Gy daily, 5 days/week (9 loooong weeks). They didn't want to miss a single day in that sequence. The intended stress on the bad cells depends on whacking them repeatedly to damage their reproductive capability, their DNA, so they die later when they try to divide.

If you're having some form of brachytherapy, the EBRT dose is adjusted since it is in addition to the brachytherapy dose. If you don't do the BT, then the EBRT dose would be increased to compensate. I don't know the relationships between BT dose, EBRT dose, or fractionation, but probably the Tall one has links to studies about it.

Definitely talk to your RO to find out what they plan to do.

I've been waiting for Tall Allen to respond but he doesn't seem to want to. Thanks for your help. You are correct ,I'll just talk to my RO went she decides to get back to me. I know very little and I just want to make the right decision. Thought it had already been made...... And screw trying to have the duodenal tumor out by the end of Oct when my insurance year turns over. What the hell does money mean anyway...

Now ,I think I'll go back out to my studio and try and get that finished and try not to think about this crap for the rest of the stinking day. Been trying to get that finished for a year now......

Mark

See above.

I've been very busy lately getting my novel Thaw's Hammer ready for publication. It's out now. I practice mindfulness, but there's nothing like art to keep one in the present moment.

You can always email me if I don't post a reply. For now, we just have to wait for the results of your urinary retention test.

- Allen

That is so true. For me, there is nothing as spiritually refreshing as immersing myself in the creative process.

If "Thaw's Hammer" has the same sales as my last novel, "Joan of Quebec," it will pay for the gas it takes to drive to Staples to buy a ream of paper.