The options that i have is to have Salvage HD brachytherapy with hormone therapy or to wait…i have a localized recurrence. with a PSA 1.5. There is a an intraductal component.
There is a 70% rate for cure if i have the salvage treatment. However, there are toxicities associated the brachytherapy.
Both acute as well as later toxicities.
I am still undecided…
The 70% is a probability........what is the prognosis if you don't do the salvage and I assume just ADT? Or do the brachy sans the ADT?
The treatment plan at MSK in NY is saying that the brachytherapy with hormone therapy has a 70% chance of cure. 60% without HT. I had the PSMA-GA 68 and bone scan done and there is no sign of cancer outside of the prostate ( as of July). If i don’t do the salvage treatment and the cancer spreads then eventually i would need to be treated having systemic disease. Then according to my oncologist i would have to be treated going on Hormone Therapy, etc. (and whatever drugs are then available).
If i have BT either with or without, there are still the toxicities…With only treating the lesion (focally), i have read that there could be less toxicity. Focally was not being encouraged by any of the doctors who i am consulting with…if i do BT, then whole gland would be recommended…
According to my oncologist he doesn’t necessarily see going on ADT alone (now) since my PSAs and localized recurrence is not “behaving” like i need it at this point.
Hi, Billy: BT was the biggest mistake I have made of all my treatment decisions. It was really bad for me. Get a second opinion. I wrote yesterday about my BT and Cryo experience in response to a question about HBO therapy. My opinion is that Lupron is the way to go and stay on it. Your PC is still in the gland! Rejoice! Approx. 20 years after my BT (66 seeds) I was having a hard time passing urine. A blockage and painful. I went to a great Oncologist at USC Norris Cancer Hospital in L.A. He immediately did a cystoscope. He said, " there is a big boulder sitting at the entrance to your Urethera. No wonder you can't pee." Next day I went into surgery. Came out with a Foley Catheter. He busted up 7 large stones with a Lazer and removed the pieces. He said the inside of your bladder looks like it needs a shave. What? He said the BT seeds were migrating from my prostate gland into my bladder sticking out of the bladder wall like beard stubble. Any foreign materials in the bladder are attacked by the body by wrapping it in calcification. Thus, Bladder stones. He removed the seeds he could get to, but saw others just under the tissue which hadn't broken through yet. Over the next 18 months or so I had the same procedure twice more. Since your PC is still in the glad, I would opt for more conservative therapy - drugs and keep your powder dry for if and when the big guns are needed.
Good Luck.
Sheba,
Sorry to hear about your circumstances. Did you have both cryotherapy and seeds?
When first diagnosed i was thinking about seeds but chose EBRT…However, now 15 years later this is HD (high dose) brachytherapy not the seeds. It would be a salvage treatment …Having had the radiation before, i am concerned about any adverse events (toxicities)…BTW, what is HBO therapy?
Bill
I am not aware of HD Brachy. What is it? I got the seeds in Nov.of 1999. The Cryo was in May, 2004 due to a rising PSA and failing Casodex. HBO is Hyperbaric Oxygen therapy. It is the Hyper intake of your blood with oxygen. Almost the same a a diver with the Bends.It is a wonderful therapy. Look it up. I had 60 hours in a tank over 30 days at a pressure of approx. 45 ft. below sea level. You wear a mask and breathe almost 100% Oxygen. Take breaks every 20 minutes (but still under pressure) Cancer hates Oxygen. It causes the small Capilaries to reach out into damaged tissue and give it new life. I had to do it because of damage caused by Brachy Seeds and Cryo (radiation cystites). I have had many different therapies since 1999. I'm really not sure which ones were benificial. Thanks.
HD high dose brachytherapy is when they place radiation (approx. 10-13 grays (gy) directly in the prostate for about 15-20 minutes and then remove it…. MSK would do this twice happening 2 weeks apart…They are careful in conforming it around the urethra (less of a dose). Also using a SpaceOar to protect the rectum… Nevertheless, urinary frequency, incontinence, and/or urinary retention can happen. These are either acute or late toxicities. In some circumstances (urethra strictures can happen!) (The recommendation is to do the whole gland.)
How has it been being on hormone therapy for all of this time…Do you have many side effects by now?
Datolli in Sarasota is allegedly very skilled at this type of thing.
Definitely worth flying out and getting a second opinion from him.
cesces, Thanks…i’ll look into this…
Whoever does it, i am concerned about the toxicities…
cesces,Do you know if they give second opinions if i send them my MRI and biopsy slides?
Thanks!
They will want that, but if you try that with them I am highly confident that they will tell you to f-off.
Why on earth would you want to cut corners on something like that? All you will do will label yourself as a difficult client.
They will tell what they need and want, then determine if they will give a second opinion, and if so how they will do it.
I can't imagine them not wanting to do their own MRI. And if they didn't I wouldn't trust their second opinion.
If it is clear from what you send them that there is no way they can help, then maybe they might forgo hands on.
They are right about the treatment being successful. My husband was treated at MSK and had brachytherapy( 1 dose), 5 doses of pelvic radiation and 18 mths of hormone therapy. His PSA is undetectable and prostate MRI shows no sign of tumor. But be careful about blood pressure which can plummet dangerously due to the combo of radiation and hormone therapy.
Hi Vitamin,
Thanks for your response… Did your husband have “salvage” Brachytherapy due to a recurrence? (I had external beam radiation initially 15 years ago… ) This High Dose BT would be done because i have a localized recurrence…There are toxicities (SEs) associated with it..
Did he have any side effects except for the blood pressure being a problem? Thank you about that information since i have atrial fibrillation…
Bill
No, it was after his initial diagnosis so we have no information about “salvage” brachytherapy. The low BP and resulting dehydration were serious enough for a visit to the ER but resolved quickly.
Best of luck to you.
Brachytherapy leakage 
Brachytherapy
Salvage radiation worries
Cystoscopy post salvage radiation 
