Considering High-Dose Rate Brachytherapy

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Subdenis
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Date Joined Aug 2017
Total Posts : 254
   Posted 12/6/2017 2:53 AM (GMT -7)   
Thought I was sold on surgery but met with RO yesterday and was pleasantly surprise by his assessment and recommendation. He also confirmed if I was to do surgery that Dr. Patel is the best. However, the ease of BT has caught my attention.

Love to hear from others who have experienced this treatment. Thanks, Denis

Saipan Paradise
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Date Joined Sep 2017
Total Posts : 116
   Posted 12/6/2017 3:35 AM (GMT -7)   
Subdenis—
I’m taking the liberty of posting your stats (SP):
65YO healthy man, PSA 5/17 4.6, MPMRI, 5/17 lesion. 13 core biopsy 3 positive 3+3 and 1 positive in a lesion, All cores less than 30% 8/17 - the second opinion Yale pathology shows a small amount of (3+4) in one core, < 5%, decipher test shows intermediate risks, looking at treatment options. Meeting with new surgeon and RO in a couple weeks to make the decision. Thanks Denis
Age 60 at dx
Dx July 2017 after biopsy G8 (4+4), 5/13 cores, bone scan clear
RARP Aug 11, 2017 (Dr Patel)
Post surgery pathology: pT3a, tumor 30% of gland; EPE+, SV- and 3 lymph nodes clear
PSA 1/2016, 2.9; 4/2017, 7.2; 9/25/2017 (first post-RARP), 0.13; 10/10/2017, <0.05

fiddlecanoe
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Date Joined Oct 2016
Total Posts : 225
   Posted 12/6/2017 4:06 AM (GMT -7)   
I had surgery first and then salvage radiation. For me, the radiation was a breeze. I went in each morning at 7:30 with a full-ish bladder, lay down on the table while the machine rotated around me, and then I went to work. Side effects were nearly zero. Side effects of surgery (of the ED variety) were considerable, by contrast. It may be that I should have started with radiation, but the prospect of several months of ADT was enough to scare me away from RT and into surgery.
Age: 62
Diagnosed in July 2016 with G7 (4+3) PC & PNI
Bone & CT scans clear
Surgery at Lenox Hill Hospital in NYC, 9/12/2016
Post-surgery pathology showed G7 (3+4), with SVI and PSM
Lymph nodes clear
First post-surgery PSA October, 2016: <.008
Second post-surgery PSA December, 2016: 0.01
Third post-surgery PSA June 2017: 0.05
IMRT begun: July 18, 2017 (35 fractions)
First post-SRT PSA: <.008

Fl Drifter
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Date Joined May 2016
Total Posts : 294
   Posted 12/6/2017 7:07 AM (GMT -7)   
Glad to hear your finally looking into something besides surgery ! GOOD LUCK ! plenty of guys here have had BT and there is much to read about it ........David
67yr.-PSA 10(2016).. 12 Biops 7 of 12 cancer ...Gleason 7-T2c-neg. bone scan and neg iodine MRI - 3+3=6 50% 3+4=7 60% 4+3=7 20% 3+4=7 60% 3+4=7 50% 3+4=7 30% ( all in left apex) then 3+3=6 5% in right apex...Lupron (6mo) shot 6-16... Markers-45 fractions of IGRT,,,81 Gy...starting fractions Oct.2016...finished on Dec.20th ..1st PSA-.4(4-2017)2nd PSA .7(8-2017)

dbell
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Date Joined Nov 2017
Total Posts : 30
   Posted 12/6/2017 7:39 AM (GMT -7)   
fiddlecanoe said...
I had surgery first and then salvage radiation. For me, the radiation was a breeze. I went in each morning at 7:30 with a full-ish bladder, lay down on the table while the machine rotated around me, and then I went to work. Side effects were nearly zero. Side effects of surgery (of the ED variety) were considerable, by contrast. It may be that I should have started with radiation, but the prospect of several months of ADT was enough to scare me away from RT and into surgery.


Agreed! I am pursuing AS for now, but if Radiation can have basically the same long term results as surgery without the "ED" and incontinence side effects. Not sure why you would not seriously consider and/or investigate some kind of Radiation therapy?! I am a newby to the club so I am sure some veterans may object to my statement/observation, but that is my feeling at this point! Only downside is mental......that have not eradicated the cancer from your body?! Really depends on many factors as everyone is different! But the SE of surgery would certainly weigh in my decision process. Any thoughts on this?

Age 53
DX 11/17 PSA 5.1
BX - 1 of 12 involved - 35%, BX confirmed by MSKCC
G 3+ 3 - AS for now awaiting MRI in 1/18

Post Edited (dbell) : 12/6/2017 2:38:52 PM (GMT-7)


Buddy Blank
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Date Joined Jan 2013
Total Posts : 1398
   Posted 12/6/2017 8:55 AM (GMT -7)   
Had LDR back in 2013. Was about a 30 minute procedure. Put out for it. No ED (in fact, I seem to be harder than ever), no incontinence and, so far, knock on wood, cancer free.
Biopsy right prostate: Benign tissue
Biopsy left prostate: Prostatic adencarcinoma, Gleason score 7 (4+3), 2 of 10 cores, 5% of total tissue sampled, Stage T1c, positive for PNI
66 Pd-103 seeds implanted 3/13
PSAs: 4.76 5/12 - 4.23 8/12 - 3.98 10/12 - 4.9 2/13 - 2.9 6/13 - 2.7 11/13 - 1.31 3/14 - 1.07 7/14 - 0.69 10/14 - 1.6 3/15 - 2.0 6/15 - 0.64 8/15 - 0.68 4/16 - 0.16 11/16 - 0.12 6/17

Michael_T
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Date Joined Sep 2012
Total Posts : 2540
   Posted 12/6/2017 9:05 AM (GMT -7)   
I had HDR brachy, although in conjunction with IMRT. (And HT, since I'm a masochist.) I'm about 4.5 years out from treatment. My only real SE is that I pee with about 80% of the force that I used to. It's back to 100% if I pop a Rapaflo, which I do about once a week or so. So far I have excellent cancer control as a G9, although as mentioned I didn't have the brachy as a mono therapy.
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
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Date Joined Jul 2012
Total Posts : 8951
   Posted 12/6/2017 9:42 AM (GMT -7)   
It is not a good idea to get "sold" on anything until all the info is in, and at least a few weeks after that. Those cognitive biases are nasty at filtering info you need.

(Saipan Paradise - thanks for posting his stats - newbies don't understand how important it is for getting a meaningful response)

I strongly considered HDRBT monotherapy when I was choosing. Fortunately, I have the best (Demanes) in my backyard. There are a variety of monotherapy protocols that vary the number of insertions, the delay between insertions, the number of fractions, and the dose per fraction. The outcomes don't seem to matter, other than it should never be done in a single fraction.

Experience is important. I remember looking at a report from Moffitt a few years ago, and making a mental note to not recommend to anyone that they go there for it. They have hopefully come along on the learning curve by now.

Frankly, I could have tossed a coin between SBRT and HDRBT. They are radiobiologically identical with respect to doses to the planned target volume and organs at risk. Oncological outcomes and toxicity are nearly the same. There is more data on HDRBT because it was begun in 1995, while SBRT was started in 2003. In the end, I decided for SBRT on the basis of convenience and cost. If possible, I wanted to avoid anesthesia and hospital stays.

Here are some questions to ask at an HDRBT interview:
/pcnrv.blogspot.com/2017/12/questions-to-ask-high-dose-rate.html

And here's an article about it:
/pcnrv.blogspot.com/2016/08/high-dose-rate-brachytherapy-hdrbt.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

JNF
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Date Joined Dec 2010
Total Posts : 3413
   Posted 12/6/2017 10:22 AM (GMT -7)   
I am fully supportive of HDRBT as it has worked very well for me.

It is not often that we can suggest a clarification to something that Allen reports; but Dr Demanes actually started using HDRBT in 1981. For several years he used both HDRBT and permanent seeds until the mid 1990"s when he stopped using seeds and only used HDRBT. That would coincide with the 1995 date that Allen reported.

So a long history of success and evolution into fewer fractions needed and mono-therapy for the lower risk men. The procedure is excellent, but more important is the provider. They have to be specialists and use the procedure often, just as with any treatment method. My doctors have been doing 6-10 HDRBT PCa procedures per week for more than 15 years.
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. Located in Cumming Georgia north of Atlanta

NKinney
Veteran Member


Date Joined Oct 2013
Total Posts : 740
   Posted 12/6/2017 10:34 AM (GMT -7)   
Do you find yourself swayed by the most recent sales pitch you receive? A lot of PC patients do, especially when they are inexperienced and insecure in the depth of their knowledge. Article LINK, Oct 2017

Subdenis
Regular Member


Date Joined Aug 2017
Total Posts : 254
   Posted 12/6/2017 10:35 AM (GMT -7)   
Thanks all not sure what happened to my stats there have been there for some time.? Denis

Subdenis
Regular Member


Date Joined Aug 2017
Total Posts : 254
   Posted 12/6/2017 11:00 AM (GMT -7)   
Tall Allen thanks for the links, they provide good positive information. Still not sure what happened to my stats. Denis
65YO healthy man, PSA 5/17 4.6, MPMRI, 5/17 lesion. 13 core biopsy 3 positive 3+3 and 1 positive in a lesion, All cores less than 30% 8/17 - the second opinion Yale pathology shows a small amount of (3+4) in one core, < 5%, decipher test shows intermediate risks, looking at treatment options. Meeting with new surgeon and RO in a couple weeks to make the decision. Thanks Denis

HitchHiker
Regular Member


Date Joined Nov 2015
Total Posts : 173
   Posted 12/6/2017 11:33 AM (GMT -7)   
Happy HDR-BT experience here. My story thread is listed in my sig. My only sig update is my PSA dropped to 0.8 in 8/17 - I just updated my sig now.
Warm Regards-CJ-age 45

Dx 11/13@42YO - PSA 5.8, -DRE, GS6, MPMRI G-Bx@JH - 1/12 cores+@<5% - AS started
11/14@43YO - NIH T3 ERC-MPMRI, PSA 5.84, PSA-D 0.127
5/15@43YO - Bx, -DRE, PSA 6.41, 6/18 cores+, unilateral all G6@<5-75%
2/16 - HDB-m@FCCC, PSA 6.6, stage T1C
PSA - 6.6 2/16, 6.0 8/16, 2.0 2/17

My Story

Post Edited (HitchHiker) : 12/6/2017 11:37:21 AM (GMT-7)


Tall Allen
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Date Joined Jul 2012
Total Posts : 8951
   Posted 12/6/2017 11:37 AM (GMT -7)   
JNF-

You are quite right. I was reporting the date HDRBT was first used as a monotherapy. It's use as a boost therapy goes back to 1986 at Kiel University in Germany. It was actually first used as a monotherapy in Osaka in '95 - Demanes and Martinez tried the monotherapy a year later in the US. It was a bold move -- according to everything known at the time about radiobiology, it should not have worked as a monotherapy - his total dose of only 42 Gy was thought to be way too low to be curative. Yet it worked much better than the EBRT dose of about 70 Gy that was prevalent at the time. It led to a reassessment of the radiobiology of prostate cancer. That was why Dr King, at Stanford at the time (Demanes was in Oakland then), looked at CyberKnife. CyberKnife had been invented by John Adler at Stanford for brain radiation because of its unprecedented precision. King adapted it in 2003 for prostate, pretty much imitating the dosimetry that Demanes was using. There is still much to be learned about PC radiobiology -- extreme fractionation (HDRBT and SBRT) works better than current models predict (the linear/quadratic model), so some believe that the now standard accepted model ought to be refined to account for the additional cell-kill and low toxicity.
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

Saipan Paradise
Regular Member


Date Joined Sep 2017
Total Posts : 116
   Posted 12/6/2017 11:44 AM (GMT -7)   
Subdenis said...
Thanks all not sure what happened to my stats there have been there for some time.? Denis

Not your fault, Denis, it’s a glitch of the old HW software. You need to log out and then back in every couple of days or the signature gets dropped. It’s happened to me many times.

dbell
Regular Member


Date Joined Nov 2017
Total Posts : 30
   Posted 12/6/2017 12:51 PM (GMT -7)   
NKinney said...
Do you find yourself swayed by the most recent sales pitch you receive? A lot of PC patients do, especially when they are inexperienced and insecure in the depth of their knowledge. Article LINK, Oct 2017


Thanks Nkinney....the article link/URL was informative too! With new DX, your initial impulse to "Get the cancer out" so surgery is the logical solution to your problem (I went through this as well and was advised by my URO (a surgeon) to have surgery). Again, that is before research and talking to various doctors and RO.

Age 53
DX 11/17
PSA 5.1
Biopsy -1 out 12 cores - 35% involved - G 3+3
AS - currently awaiting and MRI around 1/18

Post Edited (dbell) : 12/6/2017 2:33:54 PM (GMT-7)


Paxton
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Date Joined Aug 2016
Total Posts : 912
   Posted 12/6/2017 1:16 PM (GMT -7)   
NKinney said...
Do you find yourself swayed by the most recent sales pitch you receive?


Psychologists have long been aware of this. They call it the principle of Recency/Primacy. The last message heard is seen to be the most important or most applicable.
Age 68 at Dx
PSA history: 2000-2012 0.9-1.2; 06/2012 started T replacement
2013-2015 3.0-3.3 (new normal); 11/2015 4.6; 05/2016 5.7
Biopsy: 12-core biopsy 07/2016; 3 cores G3+3, 5% or less; 1 core 3+4, 15%; 1 core HGPIN; 2% of gland involved. Summary G3+4.
CyberKnife SBRT with Dr. Hirsch; start 11/15/16, finish 11/23

Subdenis
Regular Member


Date Joined Aug 2017
Total Posts : 254
   Posted 12/6/2017 1:23 PM (GMT -7)   
lets see if my stats are back
65YO healthy man, PSA 5/17 4.6, MPMRI, 5/17 lesion. 13 core biopsy 3 positive 3+3 and 1 positive in a lesion, All cores less than 30% 8/17 - the second opinion Yale pathology shows a small amount of (3+4) in one core, < 5%, decipher test shows intermediate risks, looking at treatment options. Meeting with new surgeon and RO in a couple weeks to make the decision. Thanks Denis

HitchHiker
Regular Member


Date Joined Nov 2015
Total Posts : 173
   Posted 12/6/2017 3:56 PM (GMT -7)   
Paxton said...
NKinney said...
Do you find yourself swayed by the most recent sales pitch you receive?


Psychologists have long been aware of this. They call it the principle of Recency/Primacy. The last message heard is seen to be the most important or most applicable.


IME from what I've read, memory tests indicate when faced with multiple options over time, people tend to remember their initial experience, and their last experience best. The stuff in the middle often gets lost in the shuffle. smile
Warm Regards-CJ-age 45

Dx 11/13@42YO - PSA 5.8, -DRE, GS6, MPMRI G-Bx@JH - 1/12 cores+@<5% - AS started
11/14@43YO - NIH T3 ERC-MPMRI, PSA 5.84, PSA-D 0.127
5/15@43YO - Bx, -DRE, PSA 6.41, 6/18 cores+, unilateral all G6@<5-75%
2/16 - HDB-m@FCCC, PSA 6.6, stage T1C
PSA - 6.6 2/16, 6.0 8/16, 2.0 2/17, 8/17 0.8

My Story

Saipan Paradise
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Date Joined Sep 2017
Total Posts : 116
   Posted 12/6/2017 4:34 PM (GMT -7)   
Primacy/recency is what trial lawyers are taught too: the first thing you say and the last thing you say is what the jurors will remember and take with them into the deliberation room.

NKinney
Veteran Member


Date Joined Oct 2013
Total Posts : 740
   Posted 12/6/2017 4:47 PM (GMT -7)   
Saipan Paradise said...
Primacy/recency is what trial lawyers are taught too: the first thing you say and the last thing you say is what the jurors will remember and take with them into the deliberation room.

Salespeople, too. Their phrase is, "Come see me last." In this case, the doctor is the salesperson.


My input to Subdenis, or anyone with a similar favorable-risk case who is a candidate for Active Surveillance but insists on looking into aggressive treatments anyhow...go see someone who specializes in AS last. You might just decide that having that second, confirmatory prostate biopsy is a good idea after all to see if treatment is really needed...

Subdenis
Regular Member


Date Joined Aug 2017
Total Posts : 254
   Posted 12/6/2017 4:55 PM (GMT -7)   
Nkinney, thanks, AS is not an option I am considering anymore. Denis
65YO healthy man, PSA 5/17 4.6, MPMRI, 5/17 lesion. 13 core biopsy 3 positive 3+3 and 1 positive in a lesion, All cores less than 30% 8/17 - the second opinion Yale pathology shows a small amount of (3+4) in one core, < 5%, decipher test shows intermediate risks, looking at treatment options. Strongly leaning towards HDRBT, meet with Dr, Patel in two weeks. Denis

garyi
Regular Member


Date Joined Jun 2017
Total Posts : 315
   Posted 12/6/2017 7:30 PM (GMT -7)   
I also was most impressed with both SBRT and HDR Brachy. After much research I'm convinced their time has come. Plus we have a very experienced Brachy RO here in FL. Due to other conditions surgery was my only primary treatment option.

HDR & LDR Brachy combined with IMRT holds much promise for SRT, but it's still in it's infancy. Progress takes time.
70 years old @ Dx, LUTS for 7 years
PSA's never over 3.0
Ulcerative Colitis since 1973
TURP 2/16, G3+4 discovered,
3T MRI fusion guided biopsy 6/16
14 cores; G 3+3, one G3+4, Grade T1b
Second 3T MRI 1/17
RALP 7/17 Dr. Gonzaglo The Univ of Miami
G3+4 Organ confined
pT2c pNO pMn/a
Mostly Dry
10 week PSA .32
12 week PSA .40
14 week PSA .42
17 week PSA .54
Persistent PSA - 1" tumor still in cavity

oldbeek
Regular Member


Date Joined Sep 2017
Total Posts : 86
   Posted 12/6/2017 11:10 PM (GMT -7)   
HAD RP, Made decision to quick. Removing of all nerves never discussed by URO. all nerves taken, Positive margins, probably facing radiation anyway. If I had found this site with this advise, probably would have gone with. radiation.

Subdenis
Regular Member


Date Joined Aug 2017
Total Posts : 254
   Posted 12/7/2017 3:13 AM (GMT -7)   
I appreciate all the shared experiences. I think this option is best for me due to the ease of the procedure, the stats on success and the fact that my disease is the intermediate favorable stage. The RO I am seeing has done over a 1000 and is int he OR two days a week. As far as I can tell the SEs are the same or better than RP.

I was stuck on the RP for the fact that once the organ is removed the state of the disease can be better determined. I have met a few people and read about many where the disease had already escaped and needed salvage treatment. So I am leaning towards this treatment. I have one more consult with Dr. Patel and I then feel my wife and I will have all the info we need to decide. We have been studying this for four months.
65YO healthy man, PSA 5/17 4.6, MPMRI, 5/17 lesion. 13 core biopsy 3 positive 3+3 and 1 positive in a lesion, All cores less than 30% 8/17 - the second opinion Yale pathology shows a small amount of (3+4) in one core, < 5%, decipher test shows intermediate risks, looking at treatment options. Strongly leaning towards HDRBT, meet with Dr, Patel in two weeks. Denis
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