ProstRcision vs Brachy + IMRT?

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Dr Gearhead
New Member


Date Joined Sep 2017
Total Posts : 13
   Posted 10/5/2017 5:01 AM (GMT -7)   
Would appreciate any thoughts/comments on having ProstRcision done at RCOG vs having Brachy + IMRT done near my home?

Is there anything special that ProstRcision offers over Brachy + IMRT? Is it the same?

Thanks.

Dr. Gearhead
Age 71 (2017), VG Health
PSA: 11/04 1.0, 4/07 1.6, 4/08 1.3, 5/09 3.2, 11/09 2.5, 5/10 2.9, 7/15 5.1, 10/15 4.7, 4/16 5.0, 11/16 6.3, 2/17 6.2, 8/17 7.2
Gleason 9/17: 3 of 12 3+4<5%, 3+4~15%, 3+4~30%, T1C, NX, MX (CT&BS TBD)
Prostate 52gm

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3403
   Posted 10/5/2017 5:21 AM (GMT -7)   
Prostrcison is permanent seed brachytherapy and adjuvant IMRT. It is the trade name that Dr. Frank Critz uses to describe the treatment method he pioneered. His version uses the two together rather than sequentially. Thus, while the seeds are at their strongest he applies the IMRT to get a multiplying effect.

I know the system and RCOG (owned by Northside Hospital) very well. I consulted with them and my wife had a very delicate radiation treatment for breast cancer by one of their radiation oncologists. Very high caliber group and they have treated thousands of men with Prostrcision method.

I chose a similar method that uses High Dose Rate brachytherapy amd adjuvant IMRT. I chose the HDRBT over the permanent seeds for a number of reasons including a higher and quicker radiation dose that is more effective with PCa, the radiation was not left inside so there could be no seed migration, the better use of CT scans to more precisely place the radiation, etc. All of this is to improve cancer control and minimize the side effects. But, had the HDRBT not been available I would have used RCOG and the Prostrcision method. This would be convenient for me as I live in the Atlanta area. But, I also had two high caliber HDRBT radiation oncology centers available in Atlanta so I chose the HDRBT method.

Where are you located? There are several fine HDRBT practitioners in several different cities. There are more permanent seed centers as it requires less expensive technology to deliver.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 since February 2011

Dr Gearhead
New Member


Date Joined Sep 2017
Total Posts : 13
   Posted 10/5/2017 5:27 AM (GMT -7)   
JNF, Thank you for your comments.

I am located in the Hendersonville/Asheville area of western NC.

Dr. Gearhead
Age 71 (2017), VG Health
PSA: 11/04 1.0, 4/07 1.6, 4/08 1.3, 5/09 3.2, 11/09 2.5, 5/10 2.9, 7/15 5.1, 10/15 4.7, 4/16 5.0, 11/16 6.3, 2/17 6.2, 8/17 7.2
Gleason 9/17: 3 of 12 3+4<5%, 3+4~15%, 3+4~30%, T1C, NX, MX (CT&BS TBD)
Prostate 52gm

Michael_T
Veteran Member


Date Joined Sep 2012
Total Posts : 2537
   Posted 10/5/2017 8:08 AM (GMT -7)   
Like JNF, I'm another HDR brachy + IMRT guy. Certainly worked well for me, but if I'm reading your signature line correctly, you're in the favorable intermediate risk group. To that end, brachytherapy would generally be used by itself. Or, to flip that around, IMRT (or SBRT) would be used by itself.

Keep in mind that IMRT is a multi-week procedure if you're having that done away from your home. SBRT is a much briefer treatment.
Age 56, Diagnosed at 51
PSA 9.6, Gleason: 9 (5+4), three 7s (3+4)
Chose triple play of HDR brachy, IMRT and HT (Casodex, Lupron and Zytiga)
Completed HT (18 months) in April 2014
3/17: T = 167, PSA = 0.13

Dr Gearhead
New Member


Date Joined Sep 2017
Total Posts : 13
   Posted 10/5/2017 8:52 AM (GMT -7)   
Michael,

Thank you. Yes, I am aware that IMRT is multi-week. That is why I'm interested in having it done locally, if it is necessary and available nearby. My interest in Brachy + IMRT is just my nature of being cautious, in case the cancer has spread beyond the prostate. I'm a very newbee and tend to be biased on the cautious side.

I'll be meeting with my urologist a week from today to review results of CT and bone scans.

Dr. Gearhead
Age 71 (2017), VG Health
PSA: 11/04 1.0, 4/07 1.6, 4/08 1.3, 5/09 3.2, 11/09 2.5, 5/10 2.9, 7/15 5.1, 10/15 4.7, 4/16 5.0, 11/16 6.3, 2/17 6.2, 8/17 7.2
Gleason 9/17: 3 of 12 3+4<5%, 3+4~15%, 3+4~30%, T1C, NX, MX (CT&BS TBD)
Prostate 52gm

Michael_T
Veteran Member


Date Joined Sep 2012
Total Posts : 2537
   Posted 10/5/2017 9:06 AM (GMT -7)   
That approach is understandable. Just keep in mind that no treatment is a free pass and you do increase the odds of SEs as you layer things on so that's something to balance against your caution. Glad you're doing your due diligence on your options!

If you haven't seen it already, Dr Demanes at UCLA (one of the top HDR docs in the country) has some info on monotherapy vs combo treatment at this website: http://www.cetmc.com/prostate.html
Age 56, Diagnosed at 51
PSA 9.6, Gleason: 9 (5+4), three 7s (3+4)
Chose triple play of HDR brachy, IMRT and HT (Casodex, Lupron and Zytiga)
Completed HT (18 months) in April 2014
3/17: T = 167, PSA = 0.13

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8941
   Posted 10/5/2017 10:08 AM (GMT -7)   
Dr Gearhead-

There is evidence that brachy boost therapy offers no incremental benefit for men at your risk level, while compounding side effects over monotherapy (see below). It is natural in a "cancer panic" to desire overtreatment. A couple of months from now, if you put off making a decision, I think you will be glad you didn't rush into it. I think RCOG does a disservice in overtreating men with favorable risk PC.

/pcnrv.blogspot.com/2017/05/brachy-boost-therapy-should-be-reserved.html
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Dr Gearhead
New Member


Date Joined Sep 2017
Total Posts : 13
   Posted 10/5/2017 12:05 PM (GMT -7)   
Allen,

Thanks for the enlightening article on brachy-boost. In the week since my BX results I've learned a tremendous amount.

Dr Gearhead
Age 71 (2017), VG Health
PSA: 11/04 1.0, 4/07 1.6, 4/08 1.3, 5/09 3.2, 11/09 2.5, 5/10 2.9, 7/15 5.1, 10/15 4.7, 4/16 5.0, 11/16 6.3, 2/17 6.2, 8/17 7.2
Gleason 9/17: 3 of 12 3+4<5%, 3+4~15%, 3+4~30%, T1C, NX, MX (CT&BS TBD)
Prostate 52gm

halbert
Veteran Member


Date Joined Dec 2014
Total Posts : 3140
   Posted 10/5/2017 4:04 PM (GMT -7)   
Doc, IMO the goal should be to identify the minimal treatment needed for your case. Prost-rcision is designed for higher risk guys than you appear to be. I, too, got sucked in to the ads early on, and if I'd been higher risk than I was, I might have gone down that road. However, single mode treatment-either RALP or SBRT or either of the brachy treatments will likely cure you, so why go to a higher risk treatment if you don't need to?
Age at Diagnosis: 56
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA 3/10/15: 0.10
5/18/15: <.04
8/24/15: <.04
11/30/15: <.04
2/29/16: <0.04
8/30/16: <0.04
2/15/17: <0.006
8/22/17: <0.006
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024
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