Brachytherapy Prerequisites

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mjluke
Regular Member


Date Joined Jan 2009
Total Posts : 189
   Posted 4/17/2009 9:22 AM (GMT -6)   
I am scheduled for a consultation re Brachytherapy at the end of this month. I received a call from the clinic to provide some pre-consult info mostly about urinary issues- frequency, difficulty etc.
There was also a question about the location of the tumor or nodule found on the DRE. I was told that the location of the tumor ( if close to the edge of the prostate) might disqualify me as a candidate for this procedure.
 
I would appreciate any information or explanation in relation to this issue from any member familiar with the process.
 
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."


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 4/17/2009 9:54 AM (GMT -6)   
MJLUKE,
You may want to pick up the short book "Brachytherapy and IMRT" by Michael Dattoli. The only prerequsite that I know of is your prostate must be smaller than 60mm and be in such a place that the pubic arch doesn't interfere with the seed placement. A small portion of the seeds are placed outside the prostate in the margin so I don't know why a tumor close to the margin would disqualify you, unless it has already penetrated the margin; in that case I would get a good oncologist.
The urinary issues information are standard for all treatments, you would have to fill these out any time you saw any doctor for any treatment for PC. If he didn't ask you to fill out both the urinary and sexual function information I would question his abilities.
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.

As of April 10 and 7 weeks on Casodex and Proscar PSA has gone from 30 to 0.62 and protate from 60mm to 32mm. Very minor side affects. Doc says all this indicates tumor is not aggessive

Awaiting schedule for seed impants

 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 4/17/2009 10:24 AM (GMT -6)   
In my area, they said that for seeding, you had to have <7 Gleason and <PSA to be considered, and what John mentioned above with the prostate size.
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
 
 


mjluke
Regular Member


Date Joined Jan 2009
Total Posts : 189
   Posted 4/17/2009 11:17 AM (GMT -6)   
Thanks guys for your responses- I will find out for sure at the end of the month whether or not I am a good candidate for this procedure.

Could it be that where the seeds are slow- acting over a
period of several months as I understand it, the concern is that with a palpable tumor close to the margin the cancer may spread before the seeds take effect ?
 
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."


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 4/17/2009 3:31 PM (GMT -6)   
If Gleason is 7 or above they will almost always do 5 weeks of IMRT along with the seeds. This gives a higher dose with less side affects than 9 weeks of IMRT alone or just seeds alone. If you are worried about it spreading take Casodex and Proscar; they will stop it dead.
My PSA dropped from 30 to 0.6 in 6 weeks on Casodex. It also can shrink the prostate by 50% making the radiation more effective. Side affects are minimal. Minor hot flashes at night and loss of libido. (I can still get an errection, but just have no disire to.) Effects should go away in a few weeks after you stop taking it.
JT

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.

As of April 10 and 7 weeks on Casodex and Proscar PSA has gone from 30 to 0.62 and protate from 60mm to 32mm. Very minor side affects. Doc says all this indicates tumor is not aggessive

Awaiting schedule for seed impants

 

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