RP or Brachytherapy ?? Which one?? Mo... - Advanced Prostate...

Advanced Prostate Cancer
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RP or Brachytherapy ?? Which one?? Most of the posts I’ve read men seem to have RP

Gleason 9 encasement of base of the seminal vesicles

Tumor invades the posterior of the bladder wall

Thoughts ?

23 Replies

Not brachytherapy, brachy boost therapy:




I’m seeing Horwitz at foxchase for a consult

Collins at Georgetown

I Met with Karnes at Mayo yesterday and obvious he’s ready to cut!

Wish this was easier


Fox Chase was part of the above study and Horwitz does HDR brachy, which is an excellent choice for the boost part. let me know how it goes with him. The nice thing about HDR is that it can also boost the seminal vesicles and the bladder invasion (LDR can't).


This just my opinion. Gleason 9 is a serious PC state, and I’d guess that the cancer cells are already elsewhere and lurking to grow and be discovered later. If I were you I’d opt for external beam radiotherapy, preferably proton beam IMRT or SBRT ar a well known research hospital. BUT also followed with chemohormonal therapy to attack the remaining cells (yet undetetectable) elsewhere. You didn’t say, but have you had CT+MRI+bone scans? This will definitely be a major indicator on what treatment path to follow. Although most doctors do not agree with this, opening up the body to remove prostate “may” release micro cancer cells into other parts of the body and blood circulation.

My treatment suggestion is based on this theory: RT to remove the prostate as source of cancer and PSA so it doesn’t keep growing, and chemohormonal to remove mets elsewhere (detectable and undetectable in current technology). At your age, you should be able to manage all of this event. My own chemohormonal (after RT in 2006/2007) was in 2010, and I had minimal side effect and was able to work part-time. I remember going to work with a 24-hour infusion pump for adriamycin (aka red devil), among other cocktail of drugs.




neg bone scan and positive local lymph node findings

Been on Lupron and casadex since Jan 25th and was Dx Jan 10 th

Insight is always helpful


An oncologist told me that If I have a major lesion, his opinion to me was to look at surgery first if it is possible, rather than radiation, because the cumulative side effects of radiation may limit how much radiation you can do later to treat recurrences that are inoperable and can only be reached by radiation. Sometimes radiation can follow a surgery later after it has healed to clean up the area.


I beg to differ with this Oncologist. PC with low Gleason score (less than 6), yes, prostatectomy OR radiation to the prostate will probably give long remission time. However, as most of us that have been there know, when biochemical recurrence occur, i.e., after “local/initial” treatment failure, the source of PSA rise is typically from mets elsewhere beyond the prostate, e.g., prostate bed (if surgery didn’t get it all), meaning it has metastasize beyond the prostate, or lymph node(s) or bone(s) or even worse someplace that scan cannot detect. So, that argument to me is not valid. Longterm101 has mets outside the prostate. So prostate removal or RT is only step1. He has 100 more to do.

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You’re going to need ADT and some form of radiation even if you have the prostate removed so why go through the surgery? In my view RP is a part of your choice set if you are G7 (4+3) or above and there is no evidence of extracapsular extension. You clearly have extracapsular extension since you have lesions in the seminal vessicles and bladder. Every case is different and general decision rules may not apply to a given case but I’d be thinking ADT and radiation rather than surgery.

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I'd suggest reviewing ncbi.nlm.nih.gov/pmc/articl... - it is specifically about intermediate/high-risk cancer treatments. This study is a few years old, and is limited to 5 year data since this treatment regime is not much older. It was not at all "cherry picking" (low risk patients) - 31% of the patients in it were Gleason 8-10.

There are several newer studies that have recently shown up with similar or better stats, if you're interested I can try to dig them out of my voluminous stash of treatment report links - but basically - with precision radiation (Image/Guided, Intensity Modulated, Arc-treatment) and ADT results are being obtained equal to any other treatment available, including EBRT/Brachi/ADT, and with a low incidence of serious or even minor side effects.

I'm just about finished with 45 treatments (81 Gray), side effects have been minor. Some urgency in peeing at times, wake up once a night to pee (better than before treatment actually), and occasional "shart" when straining to pee. The Doctor feels the urgency and shart will go away with time.

As has been pointed out by others - my thinking was since radiation IS probably in my future if I had RP, why beat your body up with the surgery - get it radiated, once and be done with it. Other alternatives are EBRT/Brachi/ADT as mentioned, CyberKnife/SBRT/ADT. The Brachi is "invasive" (sticking things into you) but not terribly so, and I don't see too many complaints.

A question to ask the people telling you the "Once you have radiation you can't have surgery" - is ask them what the followup/salvage treatment for surgery is. In most cases - it's radiation. I can only thing of one or two instances here where people had followup surgery in the prostate area as salvage treatment.

Good luck! And don't let it get you down - you'll be with us for a long time..

Don, G9, ECE probably.


Who is your RO? Where r they located ?

Thx Don1213


Dr. Douglas Miller, at Hackensack Meridian Health, Jersey Shore Medical Center, Neptune NJ. Young, sharp, open and very easy to talk to - and happy to discuss things I find on line. He also responds to emails - which is great.

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I was Gleason 9 (and node positive) - no mets - other scans clear.

Radiation was the only option - RP would not have helped

RP doesn't sound like the best option 2 me - but I'm not a doc ....

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Who is your RO? Happy with him ? How long ago did you have radiation ? Any side effects


I was treated at a Major clinical cancer center in Ontario, Canada.

Radiation ended about 1 year ago.

My side effects have been minimal - although a major case of ED exists.

Don't know if that will resolve or not.

I will be seeing an ED specialist in the near future.

I'm aware that some side effects can take time to manifest.

4 me - so far so good ....


Did u have a RP or bracy boost?


Bonjour Ronny Baby, where where you treated was it in Toronto ?


Canada's Capital @ the OH cancer center ....

World class, as far as I know.


No - just rads and ADT.

I was G9 with PSA above 300 - 2 far gone for RP.

I'm glad I did NOT do RP - too much buyers regret out there ....

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Who was your RO?


No seeds 4 me - beam me up Scotty (last initial starts with an M)


Get a medical second opinion.... you have plenty of time to do so..... (and don't settle for "and you're ugly too" second opinion).

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 03/02/2019 8:13 PM EST


I agree with Cmdrdata! With a 7, I had Brachytherapy and 25 sessions of IMRT. This was in 2004. What Allen calls the new term..... Brachytherapy Boost. It was a term then. In my case, micro-metastatis had already occurred before my primary treatment. My PSA never really came down and ten months later a 6.8 was a 32.4. With two Mets to my spine. I immediately had chemotherapy.

With a 9, don’t jack around. Whatever primary treatment you choose, chase it with chemotherapy to tackle systemically the cancer most assuredly elsewhere in your body. It is not a bad plan to do Brachytherapy, but you must chase and be apart of your primary treatment, IMRT.

Aggressively kick this bastard while your body is strong and the tumor burden minimal. Don’t wait and see...... I have been there. With this said, you are an adult and whatever treatment you choose, is a right decision. Heck even the Brit, rest his Soul, who decided about 14 years ago that drinking his own urine was THE CURE....... lasted two years,,,,,

Gourd Dancer


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Brachy boost is actually one of the oldest therapies around - it was used at least since the mid 1980s. I doubt that chemo is needed post brachy boost because the cure results are so good. Chemo has not yet proved to be beneficial post radiation for localized prostate cancer.