Brachytherapy - question about urinary screening..

found this just now...

https://pubmed.ncbi.nlm.nih.gov/30890317/

Yes i read your post.
Hope your problems resolve and are just part of the prostatitis/shingles.

Groundhogy, here is more about the IPSS that is used when evaluating suitability for LDR Brachy. https://www.uptodate.com/contents/calculator-international-prostatism-symptom-score-ipss

Anything over 15-20 is a contraindication for LDR Brachy.

I'll just comment on Oceanfishers issues. His problems demonstrate that all treatments come with some risk of side effects. However, what he is suffering is both unfortunate and unusual. This is not typical of what men who have either LDR or HDR Brachy usually experience.

Jim

I had an enlarged prostate with a partial blockage of the urethra causing urinary problems and still had LDR brachy and external beam treatment.
Shrink the prostate with ADT first, external beam then a flow assessment. Shrinkage 63cc to 28cc but partial blockage was still there.
Had to reduce blockage with green light laser then brachytherapy. Not unusual protocol by my RO. Dattolli in Sarasota FL
Just mentioning because there are some creative options available.
Initial check would by prostate size, any urinary issues and the shape of the pubic arch(whatever that is)
9 years ago, not sure this is still a relevant choice

HDR Brachytherapy can be done with much larger prostates than Permanent seeds, 100cc is not unusual. You need to investigate it. Also, you can use generally accepted BPH methods to reduce the size like avodart, which can reduce the size 35-50% in six months resulting in a better target for brachytherapy.

Before the brachytherapy I had a flow test, to determine if I wound tolerate the seed implant, the test was interesting to say the least with catheters fore and aft.
The first urologist was incompetent and did a quick ultrasound that was useless. Said I was good to proceed. I wasn’t.The after effects of the biopsy alone almost sent me to the ER.
I was lucky to find a very experience RO. Once treatment started with someone I could trust, it was a big relief.

If you don’t pass the flow test you can fix the cause, depending on what it is, like I did
First RO wanted me to deal with the flow issue first on my own, 2nd consult with Dattoli, he was coordinating the whole plan.
My plan started with Avodart and Casodex with 3 month shot of Trelstar. Weaken the cancer for the external beam portion.
After that is when I failed the flow test and had a green light laser, ( a little of the top please)
So by the time I had the green light the cancer was already on the run and weakened

Plus meds used off label to reduce symptoms throughout based on the RO’s experience. So no catheters needed except the one I woke up with after the seed install. Taken out the next morning
Like any other medical service or procedure, get the best most experienced docs you can who specialize in prostate cancer. First primary treatment attempt is your best shot to get a cure. Good luck whatever treatment direction you go in

Anyone ever get a catheter or bladder spasm? Its where you feel like you have to pee really bad even though the bladder is empty?

Maybe thats why he suggested ADT then brachy?
So the ADT will shrink the prostate...
Will that alleviate/lower the need for longer term catheter?

Groundhogy, your prostate is just a little on the large size at 40cc. Some would consider that in the normal range.
Greenlight laser surgery is generally used on people with BPH and extra-large prostates. It is doubtful than a reputable physician would use that to treat you prior to seeds just to reduce your prostate; GLL is a surgery itself and I wouldn't think an extra surgery is necessary in your case.

In answer to your question, "So the ADT will shrink the prostate...
Will that alleviate/lower the need for longer term catheter?", the answer is likely yes. Seeds tend to inflame the prostate for a short period of time causing swelling. That swelling may inhibit urinary flow so a larger prostate to start with will be even bigger when swollen hence more chance of inhibition of flow. Men with larger prostates who choose LDR Brachy will likely get Flomax to help flow and/or have a catheter in for a few days. In my case, with a relatively small prostate, my catheter was removed before I awoke from the procedure.

I think the bottom line for you is that LDR Brachy is an option but some pre-procedure ADT will reduce the prostate size and lessen the chance of urinary flow issues. On the other hand as I previously noted, HDR Brachy is not likely to cause the same swelling as LDR Brachy and would seem to be a great choice for you - but you'll have to seek out someone who specializes in that.

Jim

@Fauntleroy: You mentioned Dr. Dattoli. FYI, here is some rather recent unsettling/stunning news: https://www.wfla.com/news/sarasota-county/prominent-sarasota-cancer-doctor-charged-with-prescription-and-insurance-fraud-police-say/

@groundhogy: I love LDR Brachytherapy. For the right patient, it generally has a high cure rate and very low SE's. But perhaps your Hopkins RO thinks you are trying to force a round peg into a square hole and doesn't feel this is the right treatment for you. If you don't like his answers of course you can look for another opinion. But even if you/them decide LDR Brachy is not the right choice, it doesn't mean you need to resort to surgery. SBRT and HDR Brachy are still excellent choices even for men with some urinary issues.

Jim

Thank you very much mumbo