Anyone had High Dose Brachytherapy?

[StephH72]

Question: Who here has had High Dose Brachytherapy radiation or knows someone who has? Not “seeds” (aka low dose) but High Dose. Husband has been offered this as an option (HD brachy followed by EBRT/IMRT) yet we’ve never met anyone who has done this and we’re trying to find out if it’s uncommon and if so why?

[Longterm101]

I had it 4 years ago in Philadelphia. No issues

[StephH72 in reply to Longterm101]

thank you for commenting! Can I ask what your diagnosis was and why you think they recommended HD brachy? We are trying to understand who typically is advised to get it?

My husband is gleason 10, 14/14 cores all over the prostate were positive at 70-100% and tumor extended outside the prostate and was abutting the rectum and pelvic floor. It has shrunk to 1cm x .9cm but is still abutting rectum although a fat plane is now visible between the two. I guess our concern is what risks come with HD Brachy and want to understand why one RAD oncologist highly recommended it (to be followed by IMRT) and one highly advised against it. They say unclear things like “risks don’t outweigh benefits” but are hesitant to discuss risks.

[NickJoy]

My husband had it last year and there were no problems.

[StephH72 in reply to NickJoy]

thank you for commenting! Can I ask what your diagnosis was and why you think they recommended HD brachy? We are trying to understand who typically is advised to get it? Gleason score, tumor size etc

[NickJoy in reply to StephH72]

At my husband's clinic it seems to be the norm for them to really blast the prostate - his was also very near the rectum - they used lu 177 to reduce the size to give them more of a margin. Not SOC but it did allow them to proceed with brachy and sbrt. Glasson 8.

[Jancapper]

Completed my HDBT on Noverber 30, 2022. Took two weeks off for recovery and then started 25 sessions of EBRT.

[StephH72 in reply to Jancapper]

thank you for commenting! Can I ask what your diagnosis was and why you think they recommended HD brachy? We are trying to understand who typically is advised to get it? Gleason score, tumor size, etc

My husband is gleason 10, 14/14 cores all over the prostate were positive at 70-100% and tumor extended outside the prostate and was abutting the rectum and pelvic floor. It has shrunk to 1cm x .9cm but is still abutting rectum although a fat plane is now visible between the two. I guess our concern is what risks come with HD Brachy and want to understand why one RAD oncologist highly recommended it (to be followed by IMRT) and one highly advised against it. They say unclear things like “risks don’t outweigh benefits” but are hesitant to discuss risks.

[Tall_Allen]

I know many. What are your questions?it is uncommon because of low reimbursement, which is too bad.

[StephH72 in reply to Tall_Allen]

my husbands tumor was abutting the rectum (they in fact assumed it was affixed to the rectum initially). Recent mri shows it’s still abutting rectum but there is a visible fat plane between Prostate and rectum now. Tumor outside Prostate went from 4cm x 5cm down to 1cm x .9cm (although first measurement came from CT and second came from mri). My over all question is does HDBR carry more risk of damage to rectum/bladder than EBRT? What are the reasons HDBR would be advised over just EBRT/IMRT? My bio explains my husband case. His current options presented to him were a) 6 weeks IMRT b) HDRT followed by 4 weeks IMRT or c) prostatectomy followed by IMRT to pelvic bed

[Tall_Allen in reply to StephH72]

Great news that fat saved the day! I think SpaceOAR would be risky even so.

Radiation, whether from inside out (brachytherapy) or outside in (external beam), carries risk of toxicity to healthy tissues. HDR-BT is unique in that catheters can be placed outside of the prostate. The dose outside of the placement falls off rapidly, as it does with SBRT, but it is not zero. They will do a dose/volume histogram to tell them exactly what the dose to healthy tissues will be. That's what the RO and the physiologist do- they find the placement that maximizes the tumor dose while minimizing the dose to healthy tissues. The new MRI-targeted linacs (Viewray MRIdian or Elekta Unity) for delivering external beam radiation are perfect for such a case.

It is also important that all the pelvic nodes in the area get treated + 2 years of ADT+abiraterone

prostatecancer.news/2021/08...

With T4 spread, I don't think surgery is a good option. Since radiation will be required anyway, what is the point of incurring combined toxicity?

[Allan65]

I was diagnosed in 2014 had HDBT in 2015. Followed by low dose external for 30 sessions. HDBT was done by Dr Joe Hsu at UCSF. I wouldn’t go to anyone else he pretty much invented this technique. All went text book until last year when had a reoccurrence so had a second course with DR Hsu. Plus ADT via Orogvyx

Nothing is perfect or 100% certain with any treatment approach , but I would not change what choice I made . SE virtually none existent, recovery was quick and leading a pretty normal life for the moment. With a close on on a few lymph nodes and of course PSA.

[bibsie]

My husband was dx 2.5 years ago. Gleason 8 and 9's....advanced and aggressive. LUPRON initially (3 month injection), then 28 sessions external radiation, then HDR-BT (all at Daba Farber/Brigham & Women's). No issues or complications, minimal side effects. Continued Lupron for a total of 24 months. PSA currently <.02 so he's on a Lupron vacation....6 month now. So far, so good. Fatigue due to low testosterone I think.

[AlvinSD]

I am currently getting treatment at UC San Diego. I have Gleason 9 with 12/12 cores positive, extension outside the prostate, LN spread and one bone met.

My RO and I discussed HDR BT as well as IMRT. He felt in my case, IMRT was the better choice and it would allow them to treat as much as possible, in the same sessions and to minimize side effects. I’m getting a total of 28 treatments where they are doing the prostate / SVs, pelvic lymph nodes and the area in my right hip socket.

The urologist did a very poor job of explaining why they would not do surgery. But, my RO explained it like Allen did above…I’d need radiation anyway with a GS9 so why bother with the surgery. Just do it all with radiation.

I’m also on Eligard and darolutamide as well. 6 cycles of Chemo were completed at the end of October.

[maley2711]

Yes, as others have cited, for his high risk disease, a number of studies have shown the best long-term metastasis-free survival is with the combo of ADT + HDBT + IMRT(including whole pelvic RT). The con is the higher probability of urinary problem......TA has compiled some data that you can read at his blog I believe. Note that not ALL studies have shown the survival advantage, but the consensus seems to be in favor of this most intense treatment..

May I ask...was your husband having regular PSA checks?

[westof]

Yep, April 26th, 2019. Took the train from CT (with "Darling Wife") to MSKCC in NYC and went home that night.

Only se that I had was a brief bout of incontinence (4-5 hours) and then all was normal.

25 days of IMRT the following July and tapered off Z&P, 01/2020. (Stopped Lupron 1.5 years earlier)

All is well...

Best

[reconjj]

I had SBRT , high dose radiation same as HDB , high dose brachy , but not as invasive .

[TylexGP]

Hi take a look at my bio but G9 T3bN1 very high risk pca. I had approx 3 months ADT+Zytiga then HDR Brachytherapy followed a month later my 20 EBRT. In my experience the ADT has been the hardest part. I’m at19 months with PSA at 0.08. Overall I have tolerated the HDR Brachytherapy and EBRT well. Also will finish my 2 years of ADT in May if all stays stable.

[tad4]

I was diagnosed with high risk PC 2yrs ago, Gleason 9. PSMA PET-CT (F18) showed no mets. Surgery was not considered, but Brachy ruled as the best option. 4-5 days in hospital, 17 rods in through the perineum into the prostate and 3 sessions of HDR. The worst part was laying on your side and having the nurses roll you over every 2hrs because you cannot move with 17 rods sticking out of your ass! Apart from that, no problems with Brachy. Next was 23csessions of EBRT. Been on ADT for 18mths, lots of SE with Zolodex but PSA now .008 and Testosteron <0.5. So, for me, hopefully, my team have chosen the best course of therapy to combat my PC. But, you never know, because we are all individuals and react differently. Best advice - stay positive and get on with life. God bless all those fighting PC.

[gegan01]

Hi. I had low dose Brachytherapy in 2009. My PSA drops to below 1.0 until in 2020 it started to increase. In November 2020 it started doubling monthly. In early 2021 my PSA was 5.3. I had a biopsy and my Gleason was 3+3. My urologist told me that since this was a recurrence, it was more serious. At first I was looking at robotic surgery, but then I talked to one of my old doctors who suggested HDR brachytherapy. I had a review of case with the Second Opinion, a group of doctors who reviewed my case. At first they looked at recommending active surveillance, but then I had another PSA test when it doubled again. With this, everyone recommended treatment and thought HDR brachytherapy was the best. I had bone density, ultrasound, PET, and a specialized MRI to determine if the cancer was still localized in the prostate or had spread. All tests indicated it was still contained.

In preparation for HDR brachytherapy, I first had a spacer inserted to keep treatment away from my rectum. Then I had two treatments of the HDR. This was completed by April 2021. Since then my PSA initially dropped to 1.0, and since then has dropped to 0.1. I suffered incontinence at first for several months and has to use pads. But it has gone away for the most part. My ED actually got better after this treatment. Not sure why.

The HDR was easier to deal with than the low dose. I am satisfied with this treatment and hope that I can stay in remission for at least another 10 years.

[ChloeSS]

My dad had his high dose brachy just over a month ago. No significant side effects and he noted that the recovery was much easier than he was expecting. He is stage t3b (high risk) and was told by two doctors that the combo of adt (2 years), hdrt and pelvic ebrt (23 sessions) would give him the best chance of disease free survival.

[Ducttape]

Hi there you Young folks! I am 72. Active before treatment. Although I have been banned from Mt Biking by my wife after a few flyinh "Scorpions" headers over the handlebars. SO am reluctantly walking (boring ).

I completed my HDR and 25 sessions of Image Guided External Rad at MD Anderson here in Phoneix . May 2022 with HDR and then June/july for the External. Had SpacOAR with HDR. Started back in 2021 2 series of with 3-month injections ofLupron prior to procedure. I was T3B (Seminal Vesicle involvment). Gleason 9 in SV and some assorted 7's in Prostate left/right No definitive mets from CT scans prior --- determined that the spots that showed up were old athletic injuries (Hip, Spine,shoulder). and made me remeber when they occured! (a few fastballs to the hips and sides; some shots to the back a few times basketball, skateboarding and surfing, in the OOOOLLLD days etc.).

Everything in procdeures went smooth. Painful urination for a few days follwoing HDR - but the Surgical Nurse walked me down the the hospital pharmacy and picked up a pack of AZO urination irritation tablets. Worked like a Champ (they do warn that urine would be orange -- and yep , it was) only needed for a few days. No incontinence, but sense of urgent incontinence for a week or so. But learned how to time it and self control to wait till bladder was fuller. No Pain. I think the mental stress for my wife was more painful to see

The extrernal beam was more of a dance -- mostly to learn how to time bladder being full and hold it until Radiation was done. I REALLY had a full bladder during the "trial" run where they set up the images and model the prostate and surrounding organs. in hind sight, probably would not have had ballder 100% full. I live about 45 minutes away and timing was uhhhh interesting. Never had to stop and water the side of the freeway...but CLOSE.

Been on Lupron ever since and the plan is 2 full years and maybe a bit more. The last two PSA reads were under .09. ( was at close to 11 before treatments). have the next test in a few weeks (6 months past procedures).

the Lupron ADT is the devil. learning to live with it.

I Did met with Urology surgeon and the R.O in the same day back in Feb of 2022 to get their views on procedures. (both in the same grouo of MD Anderson. and part of the Tumor Board that reviews all the cases) The Uro doc really felt that I was not a candidate for surgery -- get on with radiation. looking back, I was in the "cut this sucker out!" camp. But after listening to the Docs, I am pretty happy with going the Radiation route. No bowel or urinary issues.

Body changes with the Lupron brings a whole new comedy act! Charge on my friend.

Part On,

Ducttape in Arizona

[akaipop3ps]

Had HDBRT at UCLA on 08/30/2017, Gleason 9.

In addition, IMRT , Eligard and Zytiga.