seeds vs beams

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Waitman
New Member


Date Joined Jun 2010
Total Posts : 10
   Posted 8/4/2010 7:10 AM (GMT -6)   
I had a biopsy with 1 of 12 samples showing 17% cancer. Gleason is 3+3.  My Uro sugested seed inplants. When I met with the Oncologest he said there was little difference between the beam and seed radiation. He said both have the same results rates and side effects.  I got the impression that it is a matter of convience in delivery, Beam  akes lots of visits where seeds is one procedure.  I am retired at 62.  Are there ant significent differences in side effects between the two?  Judd

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/4/2010 9:45 AM (GMT -6)   
With your provided numbers, you would be a good candidate for Seeding. We have several men here, including Tudpock and JohnT, that had very good experiences with seeding. With regular radiation, you are right, it will be spread out anywhere from 6-9 weeks, and you have to go every day during the week. With the seeding, the whole process is usually over with in a single day.

Sure some of the "seeded" brothers will give you all the good advice you need on the subject.

Good luck

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one: Aug 3
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 8/4/2010 11:21 AM (GMT -6)   
Seeds alone have overall less side affects than external radiation because the dose is more controlled and limited to only the prostate. External radiation can also affect the bladder and bowels where as the side affects to these areas are rare in seeding. The seeding dose is also higher about 100gy compared to 81 gy. The immediate side affects are higher with seeding with urinary frequency and urgency for about 4-6 weeks. There are some urinary issues during radiation but come on slower and are not as severe; but both are easily tolorable. The biggest difference is that radiation takes about 9 weeks and Brachytherapy takes about 1 hour.
I would also look into active surviellance as no treatment is better than any treatment if you have very low risk PC which it apperas you have.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


RayPat
Regular Member


Date Joined Apr 2010
Total Posts : 104
   Posted 8/4/2010 11:25 AM (GMT -6)   
Waitman, I had seeds implanted 7 weeks ago. The procedure was easy and I spent about 5 hours in the hospital from check in to check out. My side effects were a little more than I expected. Needed a foley catheter for a week. Weak stream and burning for about 10 days after the catheter came out. Still having frequent urination but manageable with Flomax. Both my urologist and radiologist said my side effects were "normal". Even though I had more side effects than I expected I'm certain they were less than I'd have had from surgery. I'd choose the same treatment again if I had to choose.
Age 63

01/26/10 ...PSA 9....Referred to urologist
02/26/10 ...Met with urologist ...DRE normal but wanted to do biopsy
03/26/10 ...Biopsy done. 14 samples...3 positive on right side...all 11% Gleason 3+3
Urologist said stage T-1c.
Advised treatment. Said either surgery or radiation should work well.
4/26/10 Met with radiologist. Decided on Brachytherapy.
5/20/10 volume study done all looks good for Brachytherapy.
6/22/10 Brachytherapy done.
6/29/10 Not as quick a recovery as expected. Catheter in for a week. :>(

JoeFL
Regular Member


Date Joined Oct 2009
Total Posts : 420
   Posted 8/4/2010 1:42 PM (GMT -6)   
Waitman,
 
I actually had a combo treatment of seeds with IGRT. Side effects from both were minimal. Came home from the seed procedure same day with no catheter. Side effects were same as reported by John T above. Radiation side effects were some fatigue after the third week (only 5 weeks of treatments in my case) but that went away fairly soon after the last treatment. Mild urinary issues treated with Flomax. It was the right choice for me.
 
And hats off to your Uro. You don't hear much on this site about Uro's who recommend seeding rather than surgery. That said, you owe it to yourself to explore all the options that are available to a Gleason 6.
 
Best wishes down the road,
 
Joe
 
 

Age -67 PSA - 4.5

Biopsy  (9/4/09) - Positive in 5 of 8 cores. In those 5 cores, 5 of 11 samples were positive. Gleason 3+3=6. Stage – T1C  Ct and Bone scans negative.

 

BT performed on 12/11/09. 84 seeds of Palladium 103. Surgery at 7:30 - Home at 12:30 same day with no catheter. Blood in urine for a week. Side effects as expected -  some burning, frequency, urgency.   Resumed daily  1 ½ mile walk after 3 days. 

 

BT followed with 25 IGRT treatments beginning Feb 15 (4500 Gy's). After third week, experienced some fatigue. Now 2 months from last rad treatment - energy level has returned. Burning gone and urgency is much improved.

 

First post treatment PSA (6/1/10) - 0.1

 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4276
   Posted 8/4/2010 2:02 PM (GMT -6)   
Waitman, without seeing more of your stats it's a little hard to know if you might be a candidate for for active surveillance.  However, FYI, shown below is a link to Johns Hopkins where you can review their program and see if you think it might work for you.
 
 
The other guys have given you proper advice on the external radiation vs. brachytherapy options.  The big advantage of seeds is that you are pretty much back to normal activities (at least most of us were) within a day or two of your procedure.  Feel free to select the link in my signature if you want some details of my "journey" with seeds.
 
Good luck and let us know how you progress,
 
Tudpock (Jim)
Age 62, Gleason 3 + 4 = 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 4/10/10.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 8/4/2010 6:44 PM (GMT -6)   
The seeds PLUS a run of IGRT treatment, which provides a very high (and effective) total dose is starting to show superiority over other forms of treatment for many men, including high-risk men, than other forms of treatment...
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. I'm also looking at seeds combined with IGRT which seems to be having good results with high-risk patients..

erbob
Regular Member


Date Joined Jan 2010
Total Posts : 281
   Posted 8/4/2010 7:05 PM (GMT -6)   
Exactly ten weeks ago TODAY, I received the Brachytherapy procedure and the side effects (FOR ME) have been extremely minimal. Walked out of the facility about an hour after the procedure and did not leave with a catheter. Started Flomax that same day and have never had any issue in taking a good ole pee. Was a tiny bit of blood the second and third day but that too was minimal. I have had no problems due to the seeds and would certainly recommend Brachytherapy if the required conditions are met. Of course being almost 74 years old, I sure did not want to take the risk of having to endure some of the common side effects of surgical removal of the prostate. Hope I'm good for at least another ten or fifteen years of GOOD health. We shall see!
Bob, located in Southern Colorado

Age 73 Retired Railroader.
Dx Jan 2010, Volume 51.345
Gleason 3+4=7, second opinion 4+3=7 (Don't know which to believe)
PSA
2.6 4/96.......... 3.7 4/07
1.9 5/97.......... 3.2 1/08
2.3 4/98.......... 6.1 4/09
2.2 10/99......... 5.3 5/09
2.4 8/00......... 5.3 8/09
2.3 6/01......... 6.9 10/09
2.9 2/03......... 7.3 12/09
3.6 4/04......... 6.1 1/10
3.0 5/05......... 5.0 3/10
4.7 4/06......... 0.7 5/10 (Lupron/Bicalutamide)
Volume study at CPCC (Westmont, IL) Feb 15, 2010 = 55.7cc
On Feb 15, 2010 put on 90 days of Bicalutamide
Got LHRH Lupron shot on Feb 29,2010
Another Volume study May 24, 2010 = in mid-40cc
BRACHYTHERAPY received May 26, 2010
Received 80 I-125 (Iodine seeds)
Activity per seed (mCi) 0.373
Total activity implanted (mCi)29.80
Measured exposure @ 3 feet (mR/hr) 0.06
Received the Brachytherapy at the Chicago Prostate Cancer Center from Dr. Brian Moran
Walked in the facilty and just a few hours later walked right out.
No after effects other than just a little sore from the needle sticks but NOT serious
enough to take ANY meds for pain.
PSA to be taken in three months (Aug 2010).

Waitman
New Member


Date Joined Jun 2010
Total Posts : 10
   Posted 8/5/2010 10:27 PM (GMT -6)   
I have some questions about sex and Brachytherapy. I am 62 and have some sort of sexual activity each week. I have some ED but we have gotten around that with some oral sex and other types of stimulation. How long after Brachy can I have sex? Is oral sex safe for my wife? Will my climax be significantly changed without semen? I apologize for the bluntness and nature of these questions, But I need some direct answers to these questions from folks who know. Waitman.

erbob
Regular Member


Date Joined Jan 2010
Total Posts : 281
   Posted 8/9/2010 9:53 AM (GMT -6)   
Waitman, did you ever get all of your questions/concerns answered?
Bob, located in Southern Colorado

Age 73 Retired Railroader.
Dx Jan 2010, Volume 51.345
Gleason 3+4=7, second opinion 4+3=7 (Don't know which to believe)
PSA
2.6 4/96.......... 3.7 4/07
1.9 5/97.......... 3.2 1/08
2.3 4/98.......... 6.1 4/09
2.2 10/99......... 5.3 5/09
2.4 8/00......... 5.3 8/09
2.3 6/01......... 6.9 10/09
2.9 2/03......... 7.3 12/09
3.6 4/04......... 6.1 1/10
3.0 5/05......... 5.0 3/10
4.7 4/06......... 0.7 5/10 (Lupron/Bicalutamide)
Volume study at CPCC (Westmont, IL) Feb 15, 2010 = 55.7cc
On Feb 15, 2010 put on 90 days of Bicalutamide
Got LHRH Lupron shot on Feb 29,2010
Another Volume study May 24, 2010 = in mid-40cc
BRACHYTHERAPY received May 26, 2010
Received 80 I-125 (Iodine seeds)
Activity per seed (mCi) 0.373
Total activity implanted (mCi)29.80
Measured exposure @ 3 feet (mR/hr) 0.06
Received the Brachytherapy at the Chicago Prostate Cancer Center from Dr. Brian Moran
Walked in the facilty and just a few hours later walked right out.
No after effects other than just a little sore from the needle sticks but NOT serious
enough to take ANY meds for pain.
PSA to be taken in three months (Aug 2010).

JustJulie
Regular Member


Date Joined Mar 2006
Total Posts : 355
   Posted 8/25/2010 1:04 PM (GMT -6)   
Hello Waitman:
 
How about some answers from the wife of a "seeded brother".  My husband had Brachytherapy and, trust me, there is no problem in the "plumbing" department.  As for return to sexual encounters, we waited until he was feeling up to it - no pun intended.  As for the difference without semen - that is not always the case - some men experience dry orgasm, some reduced semen and some (lucky me) still have to deal with the "wet spot" LOL.
 
Don't be embarassed by your blunt questions, I learned long ago, there is no room for modesty here and honesty is the best policy so there you go - carry on :)
 

Kongo
Regular Member


Date Joined May 2010
Total Posts : 36
   Posted 8/25/2010 10:48 PM (GMT -6)   
You may also wish to investigate CyberKnife radiation treatment which has many of the advantages of convenience and dosage concentration in the prostate.


============================
Age:  59
Dx:  March 2010
PSA @ Dx:  4.3 (Latest PSA = 2.8 after elimination of dairy)
Gleason:  3+3=6 (confirmed by second pathologist)
Biopsy:  1 of 12 cores contained adenocarcinoma at 15% involvement and no evidence of perineural invasion
DRE: Normal
Stage:  T1c
Bone scan and chest x-rays:  Negative
Prostate Volume: 47 cc
PSA Velocity:  0.19 ng/ml/yr
PSA Density:  0.092 ng/ml/ccm
PSA Doubling Time:  > 10 Years
Treatment Decision:  CyberKnife radiation treatment in June 2010.  Side effects:  None
 
 
 

timzter
New Member


Date Joined Feb 2011
Total Posts : 2
   Posted 2/17/2011 7:51 PM (GMT -6)   
Joe - Your treatment protocol sounds identical to what is currently proposed for me. I have a Gleason 7, Intermediate Risk, Contained. My doc wants to give me 5/5 IGRT followed by seeds. It seems more logical to me to do the seeds first then IGRT. Which order was yours performed?

Thanks, Tim



Joe67 said...
Waitman,


I actually had a combo treatment of seeds with IGRT. Side effects from both were minimal. Came home from the seed procedure same day with no catheter. Side effects were same as reported by John T above. Radiation side effects were some fatigue after the third week (only 5 weeks of treatments in my case) but that went away fairly soon after the last treatment. Mild urinary issues treated with Flomax. It was the right choice for me.



And hats off to your Uro. You don't hear much on this site about Uro's who recommend seeding rather than surgery. That said, you owe it to yourself to explore all the options that are available to a Gleason 6.



Best wishes down the road,



Joe

Post Edited (timzter) : 2/17/2011 5:54:46 PM (GMT-7)


F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3997
   Posted 2/17/2011 8:06 PM (GMT -6)   
>>Is oral sex safe for my wife?<<
 
sure, as long as they don't seed your tongue cool .
 
ed
age: 55
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

GOP
Veteran Member


Date Joined Dec 2010
Total Posts : 657
   Posted 2/17/2011 8:29 PM (GMT -6)   
Waitman,
I am one of the few 'brachy's' here. Had mine on 10/4/10. I could not be more satisfied. PSA went from 6.1 to 0.24 after only 6 weeks. Sex was one of my major concerns. No complaints there either. You are correct in that there is no ejaculate...or very little. That is really no big deal. Your partner is safe from radiation after 30 days (and likely before that. Danger from seed radiation is greatly exaggerated from all that I have read). If you have had ED issues prior, be aware that you are more likely to respond to 'drugs' after brachy than you are after surgery. Take this one to the bank. Good luck in whatever course you take.

Post Edited (GOP) : 2/17/2011 6:34:43 PM (GMT-7)


GOP
Veteran Member


Date Joined Dec 2010
Total Posts : 657
   Posted 2/17/2011 8:49 PM (GMT -6)   
I would like to send you a PM, Waitman, but I don't know how to do that on this site. Perhaps that is not a feature.

JoeFL
Regular Member


Date Joined Oct 2009
Total Posts : 420
   Posted 2/18/2011 10:30 AM (GMT -6)   
Timzter,

I had seeds first followed by IGRT. I asked my rad why he chose that order. His answer was that he had done it both ways but he and his colleagues (8 other oncol/rads in this group) had come to believe (from the data in their practice) that seeds first resulted in slightly reduced side effects.

Either way you do it, I think you will be pleased with your treatment choice. If you want any other info about my experience to date please feel free to contact me at the email address in my profile. Regards,

Joe
Age 68 PSA 4.5 Biopsy 9/4/09 Bostwick Labs 5 of 8 sections (5 of 11 cores) positive-Gleason 3+3=6 Stage T1
BT on 12/11/09 (84 seeds of Palladium 103) Home same day/no catheter. Some burning, frequency, urgency for 6 weeks. No incontinence, mild ED. Normal activity within 3 days. 25 IGRT sessions ending 3/22/10 - some fatigue until 30 days after last treatment. PSA as of 12/9/10 - 0.1

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3888
   Posted 2/18/2011 11:13 AM (GMT -6)   
Also look at High Dose Radiation Brachytherapy. It is a more accurate version than permanent seeds and nothing is left in the body. That solves the issues of seed migration, being radiative while the seeds work, and limits the side effects. HDR allows the radiation to be more conformal to the area in both shape and dose. It also solves the problems associated with normal changes in the body during the 90 day period of radiation from the seeds that can result in unintended hot and cold spots.

I did the HDR with IMRT and had minimal side effects which are all gone now. Sex has been fine and the only side effects have been a lower volume of semen and for the first few times it was dark from blood. These are the same side effects that the seed procedure presents.

You can learn more about the HDR procedures and advantages over permanent seeding at www.cetmc.com. This is a site for Dr. Jeffrey Demanes at UCLA. He is a pioneer with the HDR having performed them since 1981. He also has treatment results for up to 15 years based on his experience. There is also a Dr Martinez in Michigan that publishes his long term results with HDR. Both use HDR as mono-therapy for low risk patients and HDR coupled with IMRT for intermediate and advanced patients. HDR is also used for many other cancers such as breast, head and neck, gynocological, and others.
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