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why are there so few that have Brachytherapy ??

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Posted 5/9/2007 4:20 PM (GMT 0)
I've looked at all the postings on this board back to 2004. What I dont under stand is why so few choose Brachytherapy ? Lots of canadates, gleason 6s ect but I could only find a hand full of men that had Brachytherapy. Is there something i'm missing ? I'm on the fence betweem the robot and Brachytherapy. Any more infomation would be very helpfull in my decision..thanks carl
Posted 5/9/2007 4:56 PM (GMT 0)
Brachytheraphy takes special training. I know that my doctor was just recently trained and is still being supervised by the doctor from Texas that trained him. I think if I hadn't been so far along, I would have tried it. I liked that he could get a wider margin that he thought he could surgically. In my case I would have had to had a lymph biopsy anyway, which was going to be major surgery. At any rate it is nice to evaluate all the options.

I hope things go well for you

David
Posted 5/9/2007 7:43 PM (GMT 0)

Carl:

I think that seeds are a relatively new procedure; therefore it takes time to establish a record.  Also, the placement of the seeds is very important and don't know how many doctors are really proficient at this.  I would think it would be important to find a doctor with many procedures under his belt.  There is also the fact that some of the seeds do migrate (leave the prostate) - I had read at one time it was thought that as much as 29% could migrate.  Just some of my observations.

Good luck on your journey to find a treatmen that suits YOU.

Dutch

Posted 5/9/2007 8:14 PM (GMT 0)
"...some of the seeds do migrate (leave the prostate)". True, but not true with HDR brachy - no seeds are left in the body after the procedure.

-Gordy
Posted 5/9/2007 8:16 PM (GMT 0)
4Carl,

It's just a coincidence that more surgery candidates have ended up on this site than folks who chose other procedures. Birds of a feather perhaps has something to do with whom ends up on what fourms. :-)

swim

 

Posted 5/9/2007 9:42 PM (GMT 0)
Welcome,

I'm one of few here myself that choose seeds. I had made my mind up right from the beginning that I was not having surgery. So I had the options of seeds, ext rad. or hormone. My Uro is a surgen and he suggested seeding as well as my rad.guy. My main concern was quality of life not length. After reading about the side effects all these treatments have I decided on the seeds. But everyone has to make the best choice for their own peace of mind. I'm 59, I had a glesson of 6, psa of 2.6, 2 of 12 cores showed cancer. My doctor has done about 700 seedings and the rad has done about 2,000. right now I'm 3 months post seeding and things are going fairly well, have a few small problems but nothing thats really bad. Just remeber you have to be happy with your choice, just do the research and make your choice. You may want to go to a man-to-man meeting at the ACS and talk to some of the guys there. Good luck on whatever you decide.

Posted 5/9/2007 10:32 PM (GMT 0)
Hello Carl and welcome to HealingWell.
I am Kitt. I looked at some of the major Cancer Centers and there seems to be a fairly large number that have the equipmenpt, technology and physicians with the training.
From what I understand there are two major methods of prostate brachytherapy, permanent seed implantation and high dose rate (HDR) temporary brachytherapy.
In the end, you need to do your own analysis in terms of the theoretical differences, potential cure rates, side effects, cost, time away from work, and location of treatment centers, to decide what treatment is right for you.
You have my support in your choice of treatment. As someone so wisely mentioned, at this time, in this forum, more members have opted for other modalities of treatment. That does not negate your choice.

Gentle Hugs
Posted 5/9/2007 11:14 PM (GMT 0)

Carl,

I think there are several reasons more surgery candidates seem to post here than others. 

I'm not sure the answer to that question is helpful to you for the task of your decision!

nono  DO NOT MAKE YOUR DECISION FROM INFORMATION FROM ANY ONE SOURCE! nono

It is a VERY complex decision with many subtleties. While the physicians and specialists offer neat, one-size-fits-all decision trees, you will make the final decision based on your circumstances as only you understand them. 

Talk to experts practicing every type of treatment you consider.  Recognize their passion for what they do as you consider their advice.  Then, put it all on the "back burner" for a day or two (Don't wait too long.) before you test a decision in your mind.  (I would pray about it!)  THEN, GET A SECOND OPINION FROM AN EXTREMELY QUALIFIED PHYSICIAN.

Your question is observant.  Ignoring an option is likely an uninformed decision.

Keeping you in good thoughts.

CCedar

Posted 5/10/2007 1:25 AM (GMT 0)

Carl,
I had an rrp and then later 36 EBRT radiation treatments. I think to some degree it comes to and should be personal choice. In my case I had a Gleason 3+4 and in Ontario Canada we cannot get brachy done under our Prov meds insurance if the gleason is above 6, unless you are willing to pay the whole shot. My private insurance would not pay for brachy either so I went the RRP surgery instead of radiation, a good choice since I ended up having to do the radiation as a second treatment.

Some I think just prefer to 'have it out'. Whether they believe that there is a good chance to get it all with this primary treatment or whether they think that they would just debulk a high percentage of the PCa I don't know.  As a patient i would suggest that you check each one out carefully and pick the treatment that you feel is best for you.

I wish you well! :-)

Russ D

Posted 5/10/2007 3:24 AM (GMT 0)
Dave,what seeds did they use and what problems are you having. thanks carl

Posted 5/10/2007 3:52 AM (GMT 0)

Please correct me if I am wrong.  I think I read somewhere that the numbers are about the same.  That is, as many men have brachytherapy as have surgery.  I tried to do an online search, but could not confirm this statement. 

This forum, for whatever reason, is mostly populated by those who have chosen surgery.  I think it is important to have posts from ALL different experiences.

When I first began to study different treatment methods, I found only brachytherapy patients who I could talk to.  In fact, of the handful of current PCa people I know personally. I am the only one who chose surgery.  My gleason was higher than any of those others and that is partially why I decided on surgery. My friends who chose brachytherapy are satisfied with th results.  Most have not had after procedure complications.  Only one has serious urinary problems some 8 months past brachtherapy.

Hope you find the answers you need.

Posted 5/10/2007 2:08 PM (GMT 0)
Dear Lifeguyd
Good Morning. I did do a search for statistics on the procedures but could not come up with any that gave the info re how many of each types of surgeries had been performed.
Maybe someone else has that info.
Thank you and bless you.
Posted 5/10/2007 10:17 PM (GMT 0)
4Carl,

Try Entrez Pubmed, Urology Times, Medscape Urology, prostateline.com These may get you headed in a self help direction on study/statistical information. Got more whaere these come from if you're interested but this shuold get you started. There are thousands of articles a person could wade through so take it slow. You don't to get burned out to soon. I, myself, have read approximately 10,000 studies and articles on PCa in the last 2 years. It's been an education to say the least. Take care.

Swim
Posted 5/10/2007 10:27 PM (GMT 0)
I had the I 125 seeds, 74 of them. As far as problems I got a slight infection from the overnight catheter. A couple bouts of IBS, but like I said very minor compared to what I have read of some other guys. I only get up maybe once per night and some days the stream is weak but others it is fine. I'm only about 3 months out so it is a waiting game to see what finally happens. Just do your research and then decide what you feel is best. I was going to do watchful waiting but the "noise" from the wife wasn't worth it LOL. Like I had said, quiality of life is my most important thing, not length.
Posted 5/10/2007 10:33 PM (GMT 0)
Carl, check out this link maybe you can find some info that helps.
Dave
https://www.cancer.nexcura.com/Secure/InterfaceSecure.asp?CB=265
Posted 5/10/2007 11:54 PM (GMT 0)
Hi Carl

I understand your frustration in wondering why there are so few brachytherapy patients here! I chose Proton Radiation Therapy and am in a minority here. This forum, as you have seen, is composed mainly of members who have chosen surgery. Nevertheless, I came here more to help others than to seek help. If you have read my thread entitled "Proton Radiation Therapy--My Journey With Prostate Cancer", I indicate why I opted for Proton Therapy and rejected all other treatments, including brachytherapy.

I think the key with brachytherapy is to find the best surgeon to perform the seed implants. As with all of the treatments for PCa, finding an expert doctor is often key in giving you a greater chance of achieving success after treatment (but obviously there is never a guarantee success no matter how expert the doctor is). If you want to go to a website where you can read of the stories of men who have elected the various forms of treatment for PCa, I suggest that you go to www.yana.com (you are not alone) and you should find some postings by men who have had brachytherapy (principally implant of seeds). I don't think that HDR (temporary implant of seeds) is that popular today and many medical centers who do the seed implant may not offer the HDR.

I have read that many men have had successful seed implants with minimal side effects. On the other hand, I have heard that some men experience some unpleasant urinary side effects (very slow urination and sometimes inability to urinate which requires a catheter for some period of time or other medical intervention). Some of the other negatives were well covered by "Dutch" in his posting above.

I think the key is for you to do as much research as possible about the potential side effects of this treatment, the percentage of men who experience them and to talk with other men who have had seed implants. This forum will be of limited help to you in doing so, at least at this time. If you do go forward with the seed implants, I hope that you will become an active member and enlighten others about this therapy. I have tried to so the same about Proton Therapy. If you have not seriously explored and considered Proton Therapy for your treatment, you should do so. The key is selecting the treatment that you feel is best for you!

Best of luck to you!

Dave
Posted 1/26/2008 12:32 PM (GMT 0)
I was doing a search and just thought I'd bump this to the top for anyone else who was wondering the same thing. I often feel the bias here towards surgery. I'll probably become one of those who disappears from this forum, becoming one less to provide information on experience with brachytherapy. This will happen for two reasons: I'm tired of defending my husband's choice (a choice which we both feel strongly was the right one), and secondly, my husband is having absolutely no physical issues from the seeds, so I have no overriding personal reason to be here other than to lend an ear or a shoulder to others. Normally that would be enough, but the negativity that comes across regarding what I feel is an often better option than surgery - and towards our personal choice - just isn't worth it.

My best to all of you as you continue on the road toward full recovery.
Posted 1/26/2008 2:51 PM (GMT 0)
There's more to talk about with surgery - side effects, dripping, pads, ED etc. Those of us who've had brachy don't have a heck of a lot to talk/complain about.

Try looking up a particular appliance or drug on the 'Net - most of the folks who post are the ones who have problems and hate the item.

-Les
Posted 1/26/2008 5:15 PM (GMT 0)
Ziggy9-

Two great minds with but a single thought. One a "man of few words" and the other an eloquent writer.

-Les
Posted 1/26/2008 11:25 PM (GMT 0)

Some of us have an aversion to having things implanted in our body. Some of us have an aversion to cutting and the subsequent complications or side effects. Some of us feel that Quality and Quantity are important.

Your Mileage May Vary.

Posted 1/27/2008 1:39 AM (GMT 0)
I put my two cents in here back in May 2007--see above.  While I was willing to subject my body to radiation (i.e., proton radiation), I ruled out seeds after extensive research.  While many men have had great success with the seed implants, some men have also had unpleasant urinary problems after seed implants.  The risk is that some of the seeds have to be implanted close to the uretha.  For some men, this can result in subsequent constrictions of the uretha, including complete blockage which has to be treated.  Before treatment, I feared potential urinary problems more than anything.  I am acquainted with a nurse practictioner at a major cancer treatment center who assists with the seed implants.  She told me that some of the patients do have subsequent urinary problems which have to be treated.  I have not had any urinary problems associated with my proton radiation treatments completed nine months ago.  It appears, based on research and direct contact with other patients treated with proton radiation, that they experience virtually no urinary problems after treatment; any urinary problems experienced during treatment are usually minor and disappear after treatment. In fact, while I never had any urinary problems before treatment, my urine flow seems even better now.  Notwithstanding the foregoing, I did not opt for proton radiation solely because I felt it was the best treatment to avoid potential urinary problems.  With my due diligence and medical consultations, I was able to conclude that my chance of a cure with proton radiation was just about equivalent to any other form of treatment, with a smaller risk of potential negative side effects.

I only wish that we had more members here who have had treatments other than surgery so that they can get the word out to those needing help in selecting among too many treatment choices.  Does that mean that those who did not elect surgery have had fewer side effects to deal with after treatment, and therefore don't need a forum like this?  Perhaps so.  I decided to participate here because I want to educate others about my journey with proton radiation and also to help other PCa patients no matter what treatment they select.  When I first was diagnosed with PCa, I didn't know anything about proton radiation--it didn't seem to be in the main stream of PCa treatments.  It was more difficult to find definitive research, statistics on the success of this treatment and to find others to network with who had this treatment.  With a lot of digging I did eventually get all of the help and information I needed to make an informed decision that proton radiation was best for me.  It seems that proton radiation treatments for PCa patients are now becoming more main stream, especially with many new proton treatments centers opening up around the U.S.  Proton radiation treatment, which has been around for several decades on a smaller scale until recently,  is used to treat many kinds of cancer.

Any treatment we select has potential downside risks.  We just have to decide, based upon the known risks of any treatment, what we are willing to risk in relation to the peace of mind, potential for a cure and quality of life we are trying to achieve after treatment.  The tough decision unfortunately is ours and ours alone!

Posted 1/27/2008 2:27 AM (GMT 0)
What the previous two posters have ignored is HDR brachy. I had 5 weeks of external beam and then HDR. Nothing is left in your body and I have had no urinary problems since my Tx in July and August 2005. And, although I've got other problems, my PSA is still undetectable.

-Les
Posted 1/27/2008 4:12 AM (GMT 0)

Ziggy:

Just for info purposes - only about 1/3 of the Pca patients getting proton at Loma Linda are from CA and a great many of these are not local CA.  Proton is now covered by about all major insurances and Medicare. 

Mike's Wife:

I hope you will at least check in from time to time to let us know how your husband is doing and his PSA numbers.  I sure there will always be someone looking for something besides surgery.  Take care and best wishes.

Dutch 

Posted 1/27/2008 4:15 AM (GMT 0)
Hi Ziggy

Thanks for making that important point, which I should have made.  Except for Loma Linda, whose proton treatment center is devoted largely to those with prostate cancer, the other proton centers treat many types of cancer and may limit the number of patients they will accept for PCa treatment.  At the present time, PCa patients have a greater probability of being accepted at Loma Linda. The center where I was treated (not Loma Linda) will only accept about 60-70 patients a year for prostate cancer, because they treat many other types of cancer.  They will only accept patients who are in an earlier stage of prostate cancer and have good prospects for eradicating their cancer.

Yes, it it true that some insurers may not pay for the substantially higher cost of proton treatment, which is unfortunate for those who would otherwise opt for this treatment.  Medicare will pay the full cost of proton treatment.

The eight-week period required for proton treatment is a small sacrific to make if one is covered by insurance and has the wherewithal to travel to a proton center.  However, some patients opt for an alternative treatment locally because it is quicker.  When one's life may be at stake with cancer, I don't understand such reasoning.

Dave

 

Posted 1/27/2008 6:21 AM (GMT 0)

Gordy said...
What the previous two posters have ignored is HDR brachy. I had 5 weeks of external beam and then HDR. Nothing is left in your body and I have had no urinary problems since my Tx in July and August 2005. And, although I've got other problems, my PSA is still undetectable.

-Les

Hi Les

I believe I am one of the posters that you are referring to in your message above!  I did not purposely ignore HDR brachy.  When I was researching for a treatment I was rather intriguied with HDR brachy because the seeds are not permanent.  It sounded like a very viable and less invasive type of PCa treatment. In fact, it was Andy Grove, the former CEO of Intel, who was treated somewhere in the state of Washington with HDR brachy many years ago and apparently it has been successful.  When I did my research, it appeared that HDR was not available at a great majority of PCa treatment centers and had largely been replaced by the seed implants which I was unwilling to undergo.  I never seemed to be able to get a definitive reason why HDR apparently fell by the wayside.  Perhaps the seed implants were deemed an easier and more effective treatment, but it appears that they have a greater potential risk of urinary side effects than HDR brachy. 

Dave

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