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Stay with External Beam or Consider HDR Brachy?

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Posted 6/23/2021 10:45 PM (GMT 0)
Well I'm done with the Greenlight laser surgery and while I had a lot of healing issues, it seems to have done it's job and opened a channel so I will not have to worry about getting urinary retention during external beam treatment.
I saw the RO and he seemed to really need a PSA test so I had my blood drawn.
I had a PSA test a week or so ago but will not see that clinic for results until next week so the RO wanted a current PSA
He said he'd call with the schedule etc for starting external beam again (I had 5 treatments but after the 3rd I had retention followed by catherization and that led to a paraphimosis.
However some have mentioned HDR brachy so I asked and he said they do not do HDR and he doubted I'd be a candidate for it due to me not being able to do an MRI but told me to call Sloan Kettering and see what they can do.
At this point already knowing what is in store for me, I do not mind having the external beam (some 8 weeks or more)
I guess I'm asking for input on the benefit of HDR brachy over external beam. I also do not want to go through getting records sent etc only to find HDR is not in the cards. I just want treatment to begin again.

Glen
Posted 6/24/2021 2:05 AM (GMT 0)

Hello, Glen •••

We all look after each other here ...

In regard to your next treatment decision, and with some underlying health situations which you have described in your posts, I feel it's best to let your medical team advise you and guide you --- in terms of the best treatment route for your future.

When I needed a lung surgery, after my diagnosis, my SURGEON took the lead.

When radiation was needed, my RADIOLOGIST took the lead.

When initial ADT treatments were needed, my UROLOGIST took the lead.

When chemotherapy infusions were needed, my ONCOLOGIST took the lead.

Each member of my medical team has played a primary part in my healthcare plan, over time.

The important thing is that each of my doctors LED ME THROUGH each treatment, and was there through all steps of that treatment.

That trusted bond emerges, as the treatment process continues --- and this often includes the care nurses that you will see throughout the treatment process.

Hoping for this same experience for you, Glen ---- a trusted doctor who will advise you, and then the medical team that will take care of you through every step of the treatment.

Wanting all the very best for you, with your next treatment!

Sending you my encouragement and support ----
CYCLONE ••• # Iowa State University
Posted 6/24/2021 2:17 AM (GMT 0)
Thanks Cyclone
The RO thinks external beam is the best course of action. He has told me that with lack of an MRI image it will not be as precise as he'd want it to be.
I suppose when it is completed that the PSA will be an important guide.
HDR Brachy came up only because someone mentioned it as a possibility but even that would have to be done without MRI imaging so it too will be somewhat hit or miss.
Right now I await the RO's call. He will advise me when he gets my PSA results. I'm not really clear why that is important at this point other then a "starting point" before treatment begins.
Important thing is I'm ready for action

Glen
Posted 6/24/2021 4:29 AM (GMT 0)
With G7 you do not need Brachy.
Posted 6/24/2021 10:50 AM (GMT 0)
Glen, over the time you have been on HW you have received the same good advice that most receive pre-treatment, i.e. check out all of your options before making a final treatment decision. Evidently your RO does not do HDR Brachy or SBRT. Both of those options are a LOT less hassle than a full course of EBRT. Theoretically those would provide equal opportunities to cure you. With your history of urinary retention, LDR Brachy is probably not an option.

At any rate, my advice would continue to be to explore HDR Brachy and SBRT with doctors who specialize in those fields. Then make an educated decision.

As for Duck's comment "with G7 you do not need Brachy", I have no idea what he is talking about and would suggest he expand on that before you consider that advice.

Jim

Jim
Posted 6/24/2021 11:26 AM (GMT 0)
Glen,
It appears you are a candidate for HDR brachytherapy mono-therapy due to your favorable intermediate status. You have been treated for Prostate enlargement and this may be a problem for permanent seeds brachytherapy as HDR can work well with larger prostates. I don’t know whether having Green Light treatment would affect your ability to get HDR-BT.

None of us are docs so you have to go the the HDR specialist. Search your area and find one and inquire. Same with SBRT. Just do it. You can probably start by electronically sending your biopsy results and then have a phone appointment to find out.
Posted 6/24/2021 2:58 PM (GMT 0)
Thank you JNF Duck and Tudpock 18

I called Sloan Kettering and now have to get records sent. They do not make it easy. Last time I had to "Docusign" online and it was not an easy task. Maybe I can just go to the records department.

So it looks like I'll at least explore my options. My RO suggested I call Sloan Kettering to ask so he will understand plus I may end up having the treatment with him.

Glen
Posted 6/24/2021 3:16 PM (GMT 0)
Dr Rutman who did the Greenlight surgery office staff were very nice and said they'd fax my pathology report. That part was easy. Dr Deutsch's office I left a message with. Sloan Kettering will need my biopsy, PSA's. CT scan report and radiation summary sent.

I suppose I've covered all base's and will be armed with the best course of action. I'd prefer to have it over and done which HDR brachy may provide but am okay with radiation beam if that is what it will be.
As I've read, they both can do the job with a decent success rate.

Glen
Posted 6/24/2021 3:30 PM (GMT 0)
Both are basically equal for very effective cancer control. Much better than just decent.

The advantage to HDR-BT is that it is delivers the very most conformal treatment to the prostate and seminal vesicles of any other treatment method including surgery. This translates to less collateral radiation damage when compared to external beam radiation and thus less significant treatment side effects.
Posted 6/24/2021 3:39 PM (GMT 0)
Thank you JNF that is comforting.

I've been searching the web to see if HDR has been done with only a CT scan but have not really found any clear example's. I'm sure I am not the first patient who was unable to have an MRI. My wife for example has stimulator in her back and cannot have one. Some have ferrous material such as steel screws etc and cannot have an MRI (I have a lot of hardware but it is titanium)
I'm glad my RO brought up the idea of calling Sloan Kettering because I like him and while kinda silly, do not want to offend him by going elsewhere.
Of course I want what is best for me.

Glen
Posted 6/24/2021 5:15 PM (GMT 0)
"Both are basically equal for very effective cancer control. Much better than just decent."

i second that.
Posted 6/24/2021 5:20 PM (GMT 0)
My HDR-BT was with a CT to position the catheters as many tens of thousands have been done. No need for MRI.
Posted 6/24/2021 6:10 PM (GMT 0)
Wow! Thanks JNF, So my doctor was misinformed as he said my lack of an MRI could be an issue.
Also, I wonder why such a large university attached hospital like Columbia/Presy does not do HDR? Brachy is actually my RO's specialty so it surprised me-guess he just does the LDR type.

Still have not called back so I'll call again before end of business day.
One big benefit of the brachy is my pain issue. While I can deal with it, the 15-20 minutes posing and getting the treatment over 8 weeks or more does hurt and it's not only while I'm on the "table" as it affects me all day. Being on my back is the worst position to be in.
Oh and thanks F8

Glen
Posted 6/24/2021 6:19 PM (GMT 0)

theswan said...
Wow! Thanks JNF, So my doctor was misinformed as he said my lack of an MRI could be an issue.
Also, I wonder why such a large university attached hospital like Columbia/Presy does not do HDR? Brachy is actually my RO's specialty so it surprised me-guess he just does the LDR type.

Glen

Glen, I'm glad you are following thru and at least checking out the added option. Don't forget to check out SBRT if you are so inclined. An educated patient is what you want to be.

I'm not surprised that your doc or his hospital didn't provide the other options. We have heard that many, many times on this site. Radiation has become very specialized and it's not unusual for someone who does one procedure to not be competent with another. Most of these RO's know EBRT since that's the base case. But they have branched out into the other options, e.g. LDR Brachy, HDR Brachy and SBRT and rarely does one doc provide access to all.

Jim
Posted 6/24/2021 6:29 PM (GMT 0)
Tudpock18 thanks

Yes to be honest I was a little lazy thinking about the paperwork and dealing with more appointments but I got over it. If possible, HDR brachy would be the way to go. As I said, it is painful lying on that table. I know it's weird that it hurts but I have so much scar tissue (adhesions) in my spine that even small position changes can cause agonizing spasms. I deal with it okay but if it can be avoided, why not?
I'm reading that after HDR they often suggest a course of radiation. May have to ask about that because if it's a full course then it kinda defeats the purpose.

Glen
Posted 6/24/2021 8:03 PM (GMT 0)
Glen, most, if not all, HDR-BT specialists have used mono-therapy for a decade. For favorable intermediate and low risk. That means they do not add EBRT. Many provide it in just one fraction now. Several studies have been published regarding mono-therapy.

To find specialists you can check with the American Brachytherapy Society. Here is a link.

www.americanbrachytherapy.org. Also an excellent site that explains mono therapy is www.cetmc.com.

Just do Google searches for your cities you are interested in to find HDR specialists and clinics. Also call a specialist office like Dr. Alvarez Martinez at Beaumont in Detroit and ask for specialists he knows in your area. He is the top HDR specialist in the country for some time since Dr. Jeffery Demanes at UCLA retired.
Posted 6/24/2021 8:38 PM (GMT 0)

theswan said...
Tudpock18 thanks

I'm reading that after HDR they often suggest a course of radiation. May have to ask about that because if it's a full course then it kinda defeats the purpose.

Glen

Echoing JNF, with your stats it is unlikely that an added EBRT course would be suggested after HDR Brachy. Of course the HDR Brachy specialist is the one to confirm that...

Jim
Posted 6/24/2021 8:56 PM (GMT 0)
Oh okay, thanks Jim

It has been a while since my first biopsy and it's been a while since my second. I suppose the Pca has been growing for years and just the act of discovering it does not accelerate it but of course that is in the back of my mind.

Glen
Posted 6/24/2021 8:59 PM (GMT 0)
JNF thanks for the links.
The wwwcetmc.com will not load but the other link worked fine.

Glen
Posted 6/25/2021 12:36 AM (GMT 0)
Glen, I just tried it and it worked fine for me. www.cetmc.com. Try again.
Posted 6/25/2021 12:38 AM (GMT 0)
Okay I'll try again. My eyes are not what they used to be so it may be my error

Yep! It just opened. I must have forgot to place a "dot"

Thanks

Glen
Posted 6/25/2021 1:13 AM (GMT 0)
Wow there were great cure rates in those trials at the site you sent

G
Posted 6/27/2021 4:41 PM (GMT 0)
Another "Monkey wrench"
MSK is not in my network. I have to get a valid reason to go out of network but I believe Mount Sinai does HDR and they are in network. My Medicare is a HMO
I'll get my records from Dr Deutch tomorrow and call a Dr Strock at Mount Sinai. He's listed as a top doctor and does HDR
Dr Dutsch is supposed to call me. I'll tell him I'm exploring HDR but may schedule radiation treatment if it can wait until I get an answer about whether HDR brachdytherapy is possible.
I've read that post Greenlight laser treatment it may take a couple of months before they'll do HDR to be sure that the tissue is healed. I'm almost 9 weeks out so I can wait another few weeks.
Just hope an appointment is available without too long a wait.

Glen
Posted 6/27/2021 6:41 PM (GMT 0)
Dr Strock has a great reputation

MSK out of network? I'm guessing you are on Medicare Advantage?
Posted 6/27/2021 11:04 PM (GMT 0)
Yes sadly where I live we only have two advantage plans without additional monthly cost. Both are not great.
I paid nearly $2,500 in prescription copays last year.
If no other hospital offered HDR I'd have a shot at them paying MSK but I'm in Manhattan so there are a lot of hospitals.
My residence however is at a small county called Dutchess hence the limited insurance choices.
My wife is a resident of Manhattan. We keep two places because I cannot take living in NYC 24/7 it's too busy for me

Glen
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