Brachytherapy Boost

[Badnews4me2]

I am hoping to find useful information to help my husband who has prostrate cancer. He is also on this site. Hoping to learn more about best places to go for brachytherapy boost. I understand that experience is important here as it is with surgery. Gleason 9, (4+5) 12 cores, two 8’s and three 7’s. some possible extracapsular extension. Clean bone scan. Enlarged prostrate. Has anyone out with similar numbers been through this?

[tango65]

For brachytherapy boost these are some of the possible places to consult:

UCLA, Albert Chang, MD,PhD

uclahealth.org/radonc/brach...

UCSF,

radonc.ucsf.edu/brachythera...

Dana Farber, Dr King

dana-farber.org/find-a-doct...

[Badnews4me2 in reply to tango65]

Thank you tango65, this is what I need!

[Badnews4me2]

Thank you for your reply. That’s great news, I wish you continued success.

[Collarpurple]

❤️😁 thanks for giving me support when needed

🙏🙏 from me

[Tall_Allen]

Where are you located?

[Badnews4me2 in reply to Tall_Allen]

We live in Florida. Have relatives in California.

[mcp1941 in reply to Badnews4me2]

Try Dattoli Cancer Center in Sarasota.

[Badnews4me2 in reply to mcp1941]

Thank You mcp1941

[Tall_Allen in reply to Badnews4me2]

Matthew Biagioli in Orlando specializes in a kind of brachytherapy called high dose rate brachytherapy where nothing is left inside. John Sylvester in Bradenton is one of the pioneers of low dose rate brachytherapy.

If you want to come to LA, Mitchell Kamrava at Cedars-Sinai can do both the external beam and the HDR brachytherapy. At UCLA, Albert Chang can do the HDR brachytherapy and Amar Kishan can do the external beam.

[Badnews4me2 in reply to Tall_Allen]

Thank you for this information Tall-Allen

[Badnews4me2 in reply to Tall_Allen]

Hello Tall-Allen, Thank you and all the others who have responded to my post. my husband found Dr Daniel Fernandez at Moffett Cancer Center in Tampa. We went for a consult and were very impressed with him and his staff. And have decided to work with him to get control of Jerry’s cancer. Jerry has been placed on Eligard for three months, and continuing casodex for 5 weeks to reduce size of prostrate. If successful then Brachytherapy Boost and ADT. If not, then a longer course of external radiation and ADT. We felt a great sense of relief after talking to Dr Fernandez, as he took at great amount of time with us and addressed all of our concerns, most of which without our asking.

[Longterm101 in reply to Badnews4me2]

Dr Dattoli in Sarasota Fla specializes in only LDR Brachy and is known as one of the best

I interviewed him

[Rmurchu]

Yes, DX on March 5, husband Gleason 10, clear scan, did brachytherapy boost, took zolodex (like Lupron)for 2 months and casodex prior to Brachy boost, it reduced the volume of his prostate by 1/3. His prostate volume was 56g prior to meds, was told that the cut off for brachytherapy is 58 g in volume but the volume is reduced with meds prior to procedure. After the brachytherapy he waited 2 weeks, then he is now on his 5 treatment of 23 of external beam radiation. No node affected but Ro is including pelvic node radiation as a precaution ,because of his Gleason10. Husband is 65 years of age. We chose this treatment as we read it is equally as effective as RT for survival will less risk and side effects. He is doing just fine so far, the procedure went very well no issues at all. Will be On ADT for 2 Years. Good luck on your journey.

[Hidden in reply to Rmurchu]

Before I knew the term Brachytherapy boost, I had Brachytherapy with 25 sessions of IMRT in 2003 as my primary treatment for PCa. My prostate was large, 89. Inside was a year, I went metastatic as micro-metastatic (unseen) cells had already entered by lymphatic and vascular system. It mattered not which primary treatment I had, it was too late.

There have been adjunctive chemotherapy given as a part of a trial. I believe that those trials ended early due to a lack of grants and participants. Knowing was I know now, I would have enrolled.

As it was, in 2004, I did enroll in a six month chemotherapy-hormone therapy trial which was successful for me. As such I am a proponent of aggressive treatment while the tumor burden in minimal and the body strong.

I do recognize that treatment standards have changed in the past 15 years... in my case, I went forward with non standard treatment in a clinical trial. One question that would ask my Oncologist deals with the subject of micro-metastases as it explains why some experience failure and some do not.

I wish you the best in kicking this bastard.

Gourd Dancer

[Badnews4me2 in reply to Hidden]

What a success story! I believe you are right about aggressive treatment. Thank you for your insights.

[Badnews4me2 in reply to Rmurchu]

Thank you Rmurchu My husband’s prostrate volume is 77. We were told he was not a candidate for brachytherapy because of this. I have since seen contradictory information. It is good to know that the prostrate size can be reduced. My husband is 75 and looking for an option other than surgery.

[Longterm101 in reply to Badnews4me2]

My prostate size was 73 and reduced by a 1/3 once you start ADT

[Longterm101 in reply to Badnews4me2]

I believe you can do HDR with any size prostate gland but LDR is preferred to have a smaller gland.

TA can advise

[Badnews4me2 in reply to Rmurchu]

Thank-you Rmurchu, this is the route we are taking as well with Dr Daniel Fernandez at Moffett Cancer Center. Three months of Eligard and casodex before Brachy Boost. Then 5 weeks of external radiation.

[Longterm101]

I’m having my brachyboost (hdr) at foxchase with dr Eric Horowitz

I’m Gleason 9. 4+5

He has been extremely attentive and very responsive

I live out of town and interviewed multiple docs

Let me know if I can help

[Badnews4me2 in reply to Longterm101]

Thank you Longterm, Good luck to you. We are still in the throes of trying to determine which way to go. We have surgery scheduled with Dr V. Patel in Celebration, FL. In late August. But we keep fluctuating. The pros and cons of surgery versus brachytherapy are confusing.

[GeorgeGlass]

Get surgery and make sure its a top rated doctor. The statistics showing equal effectiveness of brachytherapy are deceptive. There are several reasons why surgery would be better for you. Open surgery can be as good as robotic. It depends where the cancer is located inside you.

[Badnews4me2 in reply to GeorgeGlass]

GeorgeGlass, Thank you for your response. From everything I’ve seen, brachytherapy followed by external beam radiation, seems to have better results than surgery plus radiation for high risk prostrate patients, as far as survival is concerned, but perhaps a lower quality of life outcome after 24 months. Could you elaborate on your comments please?

[GeorgeGlass in reply to Badnews4me2]

I got IMRT followed by high dose radiation therapy because I was worried about having a heart attack during the robotic prostatectomy. I read all the published results of how successful imrt and brachy combo is. Many of those records are shown on the Seattle prostate cancer website (dont remember the exact name) Dr. Dattoli's results were part of those results. Looking back, I think a lot of the studies are skewed, using cherry-picked patients who will fair well with the procedure so the outcomes of the study will make them look good and more people will go to them to give them business. If the radiation fails like it did for me, very quickly, then you are left with no options other then to do chemo and pray for a longshot of durable remission. If you have a top-notch surgeon, they can feel for extra capsular extention and lymph node involvement etc and can also study your specific type of cancer after they have the prostate in hand. You then have salvage radiation option if needed as an option. Ultimately, I think you can be confident in NCCN guidelines that are fitted toward your gleason score. If you are a 3+3 or low % 4+3 then brachy combo is a good option. If you are a high 4+3 % or higher then I would go with surgery. The psa matters also. What is your PSA? Did you do an MRI? What does that show? How does the prostate feel in a DRE? Getting the host (prostate out) is helpful if your gleason is high. How many biopsies have you had and when did you have them? Some believe that the metastasis sometimes happens after the biopsy opens up small escape holes for the cancer to spread.

George

[Badnews4me2 in reply to GeorgeGlass]

George, Thank you for your response. My husband is highest Gleason score was 9, seven out of twelve cores positive (the rest 7’s and 8’s) Bone scan clear, MRI shows possible extracapsular extension. Surgery is scheduled for Aug 27th with Dr V Patel in Celebration, Fl. Who recommends radiation plus ADT afterward. My husband is currently on Casodex. Also going to Moffett in Tampa on the 16th Of July for a consult. Have been reading Dr Charles Myers book, Beating Prostrate Cancer: Hormonal Therapy & Diet. Although written in 2006, the fact that he beat aggressive prostrate cancer gives great weight to his opinions. He, like you, suggests getting rid of the “host” prostrate gland by surgery due to the fact that most reoccurrences happen in the prostrate gland if not removed.

[GeorgeGlass in reply to Badnews4me2]

See what Moffitt says. I had an appointment there a couple years ago with Dr. Zhang. It's kind of a crapshoot but my blood test numbers indicate a weak immune system and I hypothesize that it's from large amounts of radiation from brachy, IMRT, heart stent procedure etc. If the surgeon is good then he should be able to reduce side effects of the surgery and keep the heavy doses of radiation out of the body. Then you can use radiation in a targeted way later if you have a specific location to target. There are holistic centers (like Dr. Dean Ornish etc.) that are good at treating cancers and sometimes turning them into remission but with a gleason of 9, that gets a lot harder to do than if it was a 3+4=7 gleason. This is all just my opinion. Many of the really smart guys on this website are understandably hesitant to provide treatment choice advice because they don't want to be blamed if things dont turn out for you. Thus, my friendly opinion. Just don't wait too long and let the cancer spread more before treatment.

[Badnews4me2 in reply to GeorgeGlass]

Thanks George,

Waiting is the hardest part right now, due to the concern of cancer spreading. I’m hoping that the tumors are shrinking as my husband’s urine flow has improved substantially since he’s been on Casodex and that the Casodex is keeping the cancer from spreading while we wait for surgery. I believe Dr Patel is probably the best prostrate surgeon in our area. Since My husband has a large volume prostrate, we’re hoping that surgery will help with the urinary flow issue as well as the cancer. However we do want to hear what the Doctors at Moffett think is the appropriate course of action, and if we might have any other options.

I take all the opinions offered with gratitude and understand that we each have to decide our own course of action as none of us travel on the exact same path.

[GeorgeGlass in reply to Badnews4me2]

I wish you the best and I think you are taking logical steps. Let me know how things progress.

George

[j-o-h-n]

Greeting Badnews4me2, ... but the good news is that the Badnews4us2 members here have lots of information to help and guide you. So stick around and keeps us posted about Badnews4me.....

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 06/24/2019 8:18 PM DST

[Badnews4me2 in reply to j-o-h-n]

Thanks for your support J-o-h-n!

[Badnews4me2 in reply to j-o-h-n]

Thanks J-o-h-n, My husband really does not want to go through surgery and never really felt comfortable about the prospect. He had too many signs that the cancer was already outside the prostrate and he would need radiation in any case. He learned about as much as he could about this disease, the pros and cons of each treatment and has decided to try for Brachy Boost (five weeks )plus ADT with Dr Daniel Fernandez at Moffitt Cancer Center in Tampa. If his prostrate fails to shrink with Eligard and casodex, then will do external beam radiation for nine weeks plus ADT. We are on a new journey in life, hopefully it will allow us a good quality of life.

[j-o-h-n]

I hope and pray that his choice of dealing with "the beast" is successful. You're correct, this is a new journey but it doesn't have to be a bad one, just different. It sure gives you an appreciation and acknowledgement of all the family and friends who support you. Please remember to L A U G H. God Bless you all...

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 07/20/2019 11:35 AM DST