Considering High-Dose Rate Brachytherapy

Subdenis—
I’m taking the liberty of posting your stats (SP):
65YO healthy man, PSA 5/17 4.6, MPMRI, 5/17 lesion. 13 core biopsy 3 positive 3+3 and 1 positive in a lesion, All cores less than 30% 8/17 - the second opinion Yale pathology shows a small amount of (3+4) in one core, < 5%, decipher test shows intermediate risks, looking at treatment options. Meeting with new surgeon and RO in a couple weeks to make the decision. Thanks Denis

Glad to hear your finally looking into something besides surgery ! GOOD LUCK ! plenty of guys here have had BT and there is much to read about it ........David

Had LDR back in 2013. Was about a 30 minute procedure. Put out for it. No ED (in fact, I seem to be harder than ever), no incontinence and, so far, knock on wood, cancer free.

It is not a good idea to get "sold" on anything until all the info is in, and at least a few weeks after that. Those cognitive biases are nasty at filtering info you need.

(Saipan Paradise - thanks for posting his stats - newbies don't understand how important it is for getting a meaningful response)

I strongly considered HDRBT monotherapy when I was choosing. Fortunately, I have the best (Demanes) in my backyard. There are a variety of monotherapy protocols that vary the number of insertions, the delay between insertions, the number of fractions, and the dose per fraction. The outcomes don't seem to matter, other than it should never be done in a single fraction.

Experience is important. I remember looking at a report from Moffitt a few years ago, and making a mental note to not recommend to anyone that they go there for it. They have hopefully come along on the learning curve by now.

Frankly, I could have tossed a coin between SBRT and HDRBT. They are radiobiologically identical with respect to doses to the planned target volume and organs at risk. Oncological outcomes and toxicity are nearly the same. There is more data on HDRBT because it was begun in 1995, while SBRT was started in 2003. In the end, I decided for SBRT on the basis of convenience and cost. If possible, I wanted to avoid anesthesia and hospital stays.

Here are some questions to ask at an HDRBT interview:
/pcnrv.blogspot.com/2017/12/questions-to-ask-high-dose-rate.html

And here's an article about it:
/pcnrv.blogspot.com/2016/08/high-dose-rate-brachytherapy-hdrbt.html

Do you find yourself swayed by the most recent sales pitch you receive? A lot of PC patients do, especially when they are inexperienced and insecure in the depth of their knowledge. Article LINK, Oct 2017

Tall Allen thanks for the links, they provide good positive information. Still not sure what happened to my stats. Denis

JNF-

You are quite right. I was reporting the date HDRBT was first used as a monotherapy. It's use as a boost therapy goes back to 1986 at Kiel University in Germany. It was actually first used as a monotherapy in Osaka in '95 - Demanes and Martinez tried the monotherapy a year later in the US. It was a bold move -- according to everything known at the time about radiobiology, it should not have worked as a monotherapy - his total dose of only 42 Gy was thought to be way too low to be curative. Yet it worked much better than the EBRT dose of about 70 Gy that was prevalent at the time. It led to a reassessment of the radiobiology of prostate cancer. That was why Dr King, at Stanford at the time (Demanes was in Oakland then), looked at CyberKnife. CyberKnife had been invented by John Adler at Stanford for brain radiation because of its unprecedented precision. King adapted it in 2003 for prostate, pretty much imitating the dosimetry that Demanes was using. There is still much to be learned about PC radiobiology -- extreme fractionation (HDRBT and SBRT) works better than current models predict (the linear/quadratic model), so some believe that the now standard accepted model ought to be refined to account for the additional cell-kill and low toxicity.

NKinney said...
Do you find yourself swayed by the most recent sales pitch you receive? A lot of PC patients do, especially when they are inexperienced and insecure in the depth of their knowledge. Article LINK, Oct 2017

Thanks Nkinney....the article link/URL was informative too! With new DX, your initial impulse to "Get the cancer out" so surgery is the logical solution to your problem (I went through this as well and was advised by my URO (a surgeon) to have surgery). Again, that is before research and talking to various doctors and RO.

Age 53
DX 11/17
PSA 5.1
Biopsy -1 out 12 cores - 35% involved - G 3+3
AS - currently awaiting and MRI around 1/18

Post Edited (dbell) : 12/6/2017 2:33:54 PM (GMT-7)

lets see if my stats are back

Primacy/recency is what trial lawyers are taught too: the first thing you say and the last thing you say is what the jurors will remember and take with them into the deliberation room.

Nkinney, thanks, AS is not an option I am considering anymore. Denis

HAD RP, Made decision to quick. Removing of all nerves never discussed by URO. all nerves taken, Positive margins, probably facing radiation anyway. If I had found this site with this advise, probably would have gone with. radiation.