Brachytherapy- one or two procedures

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mjluke
Regular Member


Date Joined Jan 2009
Total Posts : 189
   Posted 4/1/2009 8:54 AM (GMT -6)   
I am considering seed therapy as a treatment option and have read that it involves two separate procedures - first a procedure to assess the size and shape of the prostate- a few days or weeks later a second procedure to actually implant the seeds.
 
Did I read on this site that it is lately being done as one procedure-- relevant for me as extensive travel involved.
 
I would appreciate any information.
 
63 years old-tumor discovered on digital exam- biopsy December 2008-
4 of 12 samples positive-all on right side
Gleason 3+3=6
PSA-3
Otherwise excellent health.
 
  "There may come a day when the courage of men will fail, but it will not be this day."


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4840
   Posted 4/1/2009 9:03 AM (GMT -6)   

It probably just depends on the doctor...hospital etc,....

Brachytherapy procedures

The first step in the brachytherapy procedure is the use of ultrasound to determine the position and the shape of the prostate. The ultrasound procedure typically takes from twenty to thirty minutes to carry out. Once the size of the patients prostate is figured out the doctor is able to calculate how many radioactive seeds are required to be inserted into the prostate for the brachytherapy. This is typical in the region of fifty to a hundred. The ultrasound also enables the doctor to reconstruct the spatial spread of the cancer within the prostate.

One of the advantages of brachytherapy is that it can be performed as an outpatient treatment. In order to for the doctor to better visualise the prostate the patient should follow a strict clear liquid diet the day before the brachytherapy treatment, and they should refrain from any intake of food at midnight on that day.

http://www.prostatecancerguide.net/brachytherapy-procedure.php


Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
 
06/25/08 - Da Vinci robotic laparoscopy
Catheter in for five weeks.
Dry after 3 months.
 
10/03/08 - 1st Quarter PSA -> less then .01
01/16/09 - 2nd Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.
 


JustJulie
Regular Member


Date Joined Mar 2006
Total Posts : 355
   Posted 4/1/2009 10:56 AM (GMT -6)   

We had two procedures - the first was the "mapping" (i.e. to determine where to lay the seeds) and the second was the actual surgical procedure to lay the seeds.

Let me know if there's anything else you want/need to know.

JustJulie


Husband diagnosed in December 2005
PSA of 3.74
Gleason 6
Brachytherapy (91 stranded seeds) April 2006
PSA of 0.39 - November 2008 - whoo hooo!
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4245
   Posted 4/1/2009 11:25 AM (GMT -6)   
There has to be a volume study done 1st to determine the amount of seeds and the seed placement. Most of the times the seeds come prearranged in tubes that have been determined by the volume study. It takes about 4 weeks to order the seed in the configuration the radiologist will use.
A good primer is "Brachytherapy and IMRT" by Dr Michael Dattoli.
JohnT

64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.

JohnT


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25382
   Posted 4/1/2009 12:06 PM (GMT -6)   
Brother Tudpock, where are you, a good question for you to answer.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 6 month on 5/9
 
 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4231
   Posted 4/1/2009 1:49 PM (GMT -6)   

,,,ok, David, here I am...

mj, in the vast majority of cases this is done in 2 separate procedures.  The volume study is done several weeks before the seeding.  The volume study allows the radiation oncologist to accurately judge the volume of the prostate and map the prostate for seed placement.  A very few doctors will do this just before seeding as they believe that they want the most current info possible on the size of the prostate.  My doc believed that that was not a good tradeoff, i.e. he felt taking the time to accurately determine seed placement was the best approach, hence my volume study was a month before my seeding.

Incidentally, the volume study for me was the worst part of the whole deal, as you can read if you choose to click the link on my journey below.  I recommend some mild relaxant pre-volume study if your doc's camera is as big as my doc's was.

Tudpock


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 3/6/09.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25382
   Posted 4/1/2009 4:03 PM (GMT -6)   
Tud, you are getting behind on your commission checks to me! lol
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 6 month on 5/9
 
 


duckfan
Regular Member


Date Joined Dec 2008
Total Posts : 40
   Posted 4/1/2009 4:59 PM (GMT -6)   
My husband just had seed implant two weeks ago. We have to travel 5 hours to get to the hospital. Because of the distance the Dr. scheduled the volumne study,anesthesiologist appt. and his pre-procedure appt. on the same day. Then we went back up two weeks later the day before, had the procedure the next day and on our way home the day after that.  Most, if not all, motels around the hospital will give you a pretty large discount.

My husband has MS and didn't have any other option than seeding. He's doing very well and we're not sorry we choose this option.

At the bottom of the page is a link to our journal.

God bless you in your search for the right answers.


62 year old with Multiple Sclerosis currently in remission
Last PSA taken in 2008 was normal
November, upon exam abnormality felt in Prostate
Biopsy taken December 10
6 samples taken
3 positive for Prostatic Adenocarcinoma
3 Negative
Gleason Score of 3+3=6
Grade T-2
Looking into DaVinci Surgery, no decision made yet.  Update, not a good candidate for surgery because of MS.
Saw a Oncologist who suggested 8 weeks of Radiation.  Not a good option because of the distance.  Would need to live away from home for 8 weeks. 
Had a MRI which showed no spread outside the prostate. 
Had brachytherapy done at Oregon Health Sciences on March 20th.  No ill effects, pretty easy procedure.
 
Link to Mr. Duck's Brachytherapy Journal
 


mjluke
Regular Member


Date Joined Jan 2009
Total Posts : 189
   Posted 4/1/2009 10:39 PM (GMT -6)   
Thanks for all your responses. Its a great comfort for me to have access to this place and the wonderful people I have encountered here.
 
63 years old-tumor discovered on digital exam- biopsy December 2008-
4 of 12 samples positive-all on right side
Gleason 3+3=6
PSA-3
Otherwise excellent health.
 
  "There may come a day when the courage of men will fail, but it will not be this day."

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