This is my first post since being diagnosed with g9 metastatic PC. PSMA PET showed several pelvic lymph nodes with Mets, but no other spread, and bones are clean.
I’m trying to finalize my choice of radiation treatments. I’m currently on Lupron and Zytiga, and PSA is dropping like a rock. So the PC seems to be responding nicely to hormone therapy. All RO’s I’ve met with want to wait 2-3 months for the ADT to do its thing and shrink the primary tumor and lymph nodes before they that radiation start treatment.
One RO I met with wants to treat with just IMRT. Another I met with wants to use HDR Brachy boost + IMRT.
I looked at studies of both, and the HDR boost appears to have better disease free progression numbers than any EBRT monotherapy.
Can anyone who has had HDR boost let me know what their experience has been like and if it was worth it? Also if anyone here with knowledge of radiation therapies could chime in with their opinions on HDR boost versus straight EBRT, I would be eternally grateful.
This is a tough decision, and I think the wonderful people here can lend me their wisdom.
Thanks.
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Cenerus
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Thanks for replying. My RO that just wants to do IMRT is very experienced, but isn't trained in Brachy, so not an option with him. I really like this doctor, so would only change of the evidence of efficacy is so strong that it forces me to.
You can do the Brachy somewhere else and have him do the IMRT. My Brachy had less side effects then the biopsy. Find the most experienced Brachy Specialist that you can. It is also very hardware and software intensive.
I was 72 y.o. and received VMAT-RT 3 Gy X 20 fx & (ADT) Lupron Depot 45 mg/24weeks.
Now, 5 years later,my PSA =0.01μg/L and I am in remission.
The VMAT-RT is a noninvasive radiotherapy compared to Brachytherapy which involves an anesthesia. In Canada 🇨🇦, Q uebec they don’t recommend the RP and the Brachytherapy for men older than 70 years old.
Thanks for that information. I’m 59 and considered young. That always makes me smile when they say it. And I’m in decent physical shape apart from the cancer. So I may be able tolerate more aggressive treatment up front.
IMRT plus HDR brachytherapy reports better results than IMRT alone. But it increases the risk of side effects. I do not know if the small increase in better oncologic results is worth this risk. You could get IMRT alone (plus RT to the pelvis to get the lymph nodes) and then use SBRT radiation later, if there is a recurrence. Since the cancer has spread, the radiation will not be curative so you may choose the therapy avoiding side effects.
I agree about QoL, but do want to make sure I'm making the right choice in terms of survival as well. I haven't found a good study that shows the risk of side effects with HDR brach therapy as a boost on IMRT yet. I'm sure there must be one out there as this treatment has been around for over 20 years.
The side effects may spoil your remaining life so I would take the risk of living e.g. two months shorter but without side effects. The new IMRT systems can implement a radiation plan to increase the dose to the visible lesions within the prostate. This may work just as well as a separate HDR brachytherapy.
No one here can tell you with any certainty based on what we know that your disease is not curative at this stage. Modern treatments make this possible where it would not have been not so long ago.
I would have opted for brachy boost with my IMRT, but was talked out of it by my RO. My only advice: with Gleason 9, don’t try to work around the ADT.
To that end…
ADT can be tough if your condition and habits are not good. Consider your overall health. How is it? Do you actually know? If you are even somewhat healthy on sight many doctors will tell you you’re healthy, ‘look great’ etc but of course that means little. Assess yourself honestly, which can be tough.
We all like to think we’re healthier than we actually are. Few docs will take this into consideration in any meaningful way, but you should. Both radiation and ADT are a challenge, one you want to be equipped to meet as thoroughly as possible.
You might want to discuss your current diet, how much aerobic and resistance training you currently do.
These are critical factors on the effects of the therapy as well as your OoL issues during and after treatment. This is critical for you on long term hormone therapy.
It maybe too late but get a Dexa test and baseline blood work for T.
Thanks for the suggestion on diet and exercise. I’ve been a workout nut since a triple bypass a year ago and have lost 45 lbs and workout every day. I also eat a very healthy diet now. I’ve been researching modifications to my diet and exercise regime to counter the effects of the hormone therapy.
You current heart healthy diet is good for the cancer. So you probably do not need to make changes there. The big thing for overcoming SE is the resistance training. Light weights, resistance bands, etc.
with g9 I wouldn’t f around .. I had tri modality at Gleason 7 unfavorable.. brachy seeds, linac 15 session boost while getting ADT for 9+ months. I’d hit it strong .. just finishing up my treatment so far side effects minimal but it’s a long processs not a quick fix… good luck
Thanks for the feedback and for sharing what you had done. My goal is to knock this cancer back to the stone age if possible while I’m still young enough and strong enough for a more aggressive multimodal treatment.
That's exactly what one of the RO's is recommending. The other RO is recommending just IMRT with boost to the prostate and the affected nodes along with whole pelvic radiation at a lower dose. What studies I could find indicate that HDR-BT with IMRT and ADT have the best disease free progression numbers. Side effect data seems to be harder to come by with both IMRT only RO's and HDR RO's each claiming better side effect numbers. I want to hit this cancer like it owes me money, but I also want to be mature about my approach and not act on fear but science. As an engineer with a some medical background and a strong interest in physics, radiation nothing I fear, but I do respect it.
"The other RO is recommending just IMRT with boost to the prostate and the affected nodes along with whole pelvic radiation at a lower dose." That's what I recommend. Your cancer has already spread so the disease free survival does not depend on the maximum radiation dose applied to the prostate.
Thanks for the guidance. I honestly would prefer that route as the risk of side effects is lower. I just want to make sure it has equivalent chance of sustained remission or even cure. But I’m realistic about the chance of cure and very interested in knocking the disease down hard enough for at least a very long remission.
I didn’t have any SE’s from HDR-BT, burning urination the first day, and some retention that ended in two weeks. Just had a colonoscopy and the rectum is clean, no radiation proctitis. Had a great BT RO, Chang, at UCLA. Results may vary, but I’d do it again.
I chose ADT + HDBTB + 25 sessions of full pelvic irradiation. My ADT, Leupron, started 3 months prior to my HDBTB procedure. My initial PSA was 11.4 at diagnosis. My RO first completed the HDBTB, which was a single procedure. One week later I started the IMRT. I have had three PSA readings subsequent to completing my therapy. My first post surgical reading taken 3 months post op was 0.09 and the two later were <0.01. Next September, I will have completed my 2 years of ADT and I expect to discontinue it at that time.
Outside of the typical “peeing glass shards” following the HDBTB procedure, as well as short lasting diarrhea (3 days) and ensuing hemorrhoids, side effects were manageable and a small price to pay for a chance for a cure.
There are many studies which show this therapy offers the best chance for survival with high risk localized cancer.
Thanks very much for sharing that. In my case the PC has spread to the pelvic lymph nodes. So I’m not sure if HDR to the prostate itself is the most important thing.
I would choose the most experienced RO and let him to decide what to do.
I believe that you are still curable therefore if you have to travel far away for the best medical advice than please do it.
Maybe Dana Farber cancer institute? You could even get online contact and medical advice from a Dana Farber RO team. Therefore you don't even need to travel to Boston.
If you where not potentially curable I would straight recommend IMRT only because all that radiation could effect your immune system and your bone marrow.
My RO that wants to just do IMRT is very experienced. He’s a PHD in RO, is a professor and the director of radiation oncology. So I don’t disrespect him at all. I reached out to him for his feedback on the HDR recommendation and he responded almost immediately that he wants to meet with me in person as soon as possible to discuss it with me. That was impressive given how busy most doctors are these days.
I'm G8 but negative on the PSMA scan and just started on Orgovyx and will take it for 2 months before 28 sessions of VMAT, including the nodes, then LDR Brachy. Before the radiation begins, I'll have another MRI and gold markers and Barrigel "installed". All this at Dana Farber. One of the world's leading docs in Brachy is there.The rationale is to do whatever is needed to knock out the PCa now. He's using VMAT over SBRT to minimize radiation side effects - as he said, at my age (75) you don't heal as quickly so spread out the dose.
BTW I first talked with the docs at DFCI as a second opinion (as Seaside mentioned) but after meeting with them, switched to them for my treatments.
Good luck with whatever you choose - every guy is different.
Thanks very much for the details on your treatment. It's good to see that there were no serious side effects in your case. And thanks for the link to a comparison of the treatments.
Based on your age, marital status, I assume you need to or are still working and need to continue. So that maybe a consideration and influence where you get treatment and the type of treatment.
It can be easy to say go here or go there but it can be more difficult based on other external issues in your life so take those into consideration. They can impact your quality of life and treatment decisions.
Yes, I'm 59 and still work. I plan to keep working as long as I can because I actually like what I do. I don't want to put my whole life on hold to move somewhere just for treatment. I think it's possible to get great treatment in this general area of Florida where I live, and I've made the effort to interview multiple RO's, MO's and a surgeon who specializes in very high risk patients such as myself.
At this point I'm convinced that radiation is best general choice, but there are lots of sub options like HDR-BT boost with IMRT versus straight IMRT or some other EBRT variant. I also want to get ahead of potential distant micro metastasis with chemo once the radiation is out of the way. This is something Dr. Mark Shultz does, and I'm interested in that approach. I'm just going to assume more spread that a PSMA PET scan can see and go medieval on the cancer.
I had the 25 sessions radiation to the prostrate and the pelvic area done. Pelvic area was a just in case scenario recommended by my RO.
I would say it was almost a walk in the park except for some fatigue and a week of diarrhea. Nothing I could not live with.
I upped my gym routine and watched my diet and lost 12 pounds. I am 9 months out of radiation and 7 months out of ADT and my T is normal and my PSA is not detectable. T was back after 2 months after stopping ADT. I was 700 at my age and I believe the aerobic and resistance training assisted a fast return.
Sounds like you have a good handle on it and you have assembled a great team. Wishing you the best!
Cenerus, the same as you, I have Gleason 9 scores in six out of twelve cores and a six on the other side. I started ADT with Orgovyx on February 27, 2024. MRI and CT scans have not detected metastasis which only means the lesions are smaller than two or three mm in size if they exist.
I experienced most of the listed side effects, but only at a level one or two out of ten. All were manageable without intervention. The worst at first were fatigue, joint pain, mental fog, and mental moroseness. Now on March 30, 2024, I feel pretty much back to normal except for feeling down, fatigue, and occasional confusion.
An occasional marijuana complex gummy and a very occasional microdose of psilocybin (magic mushrooms) helped the mental aspect and pain quite a bit. I cleared both with my medical team first.
To mitigate the bone loss, I visit a gym several times a week for cardio and weightlifting. To mitigate the mental confusion I keep my mind intensly occupied by playing new preludes and postludes at church every Sunday. I write historical action and adventure novels that require lots f mental attention for story writing.
I am scheduled to start CyberKnife radiation treatments in late April. Five SBRT sessions are scheduled.
I am starting all this foolishness at 85 years old. Who knows what healing resources I have? However, I am in excellent health, intend to fully live each day as it unfolds from the sunrise, and for as many days as possible. Years maybe?
My advice to you is to not fear treatments, to mitigate side effects as you can, and as Todd1963 posted on January 12 or 13, 2024, "Letting Go". The future is ours.
Good luck fellow traveler, and please stay in touch.
Thanks so much for the words of encouragement and for sharing your journey with me. I'm a huge fan of historical action/adventure novels. Have you published your work? I'd love to read it.
Do the imrt first then the HDR after that.I was G9, aggressive but no Mets and that is what my RO recommended. She is the Chief and has a PhD in microbiology in addition to her MD.
Interesting as here in Japan they start with ADT right away for at least 3-4 months , then do brachytherapy followed by a LINAC boost… I see the boost order that you did more frequently and am wondering if there is any difference. Good luck to you all!
The RO I talked to who is recommending Brachy boost said that is the order of things. ADT for 3-6 months. Then HDR Brachy Therapy, followed by VMAT to the pelvic nodes and whole pelvis.
He said that the longer a patient is on ADT the better for either radiation or surgery as it usually shrinks the tumors and allows the physicians to target a smaller area. The only risk is that the cancer becomes castration resistant. Patient quality of life impact from the ADT isn’t much of a factor in this scenario as being alive usually trumps hot flashes and low libido.
I agree.To clarify I was on ADT for 6 weeks the 25 sessions of IGRT followed by 2 sessions a week apart of HDR Brachy boost. Stayed on ADT for a total of 2 years. For the rest of my journey just ask.
My take is the optimist says the glass is half full: the pessimist says the glass is half empty: the Maintenance Engineer says the packaging engineer designed it wrong.
I was G9 as well. No spread showed on PSMA PET scan or bone scan. Nevertheless there is a good chance I have some microscopic spread to the lymph nodes. I discussed brachy with my oncologist but she did not think it worthwhile. So I am getting 20 sessions of VMAT IMRT to the prostate and 17 to the lymph nodes and prostate bed. This stands a good chance of being curative. I would have thought yours would have been curative as well. VMAT and BT seem to be on a par in terms of effectiveness:
I would have thought that VMAT would be more effective than BT at targeting pelvic lymph nodes. So lots to discuss with your RO. Personally I like the sound of your preferred RO.
The second RO I'm talking to would use both HDR-BT and VMAT to the nodes and whole pelvis. My first RO believes that it can all be done with IMRT using boosts to the prostate and lymph nodes along with a lower dose to the whole pelvis. This is standard of care today for metastatic PC with pelvic lymph nodes. I'm interested in bombing this cancer back to the Stone Age, so the HDR-BT boost with CMAT to the pelvis to get the lymph nodes sounds attractive provided it doesn't come with side effects or no meaningful increase to survival.
I had the HDR in the middle of my IMRT due to some scheduling issues at the hospital. Both went fineI had major fatigue and digestive issues that got progressively worse as the radiation went on and then slowly tapered off. I am G+3 and categorized as metastatic even though the bone and CT scans came back negative because te tumor covered the entire prostate. The frustrating bit, is that there is no gauge for success of the radiation treatments. The only feedback is the quarterly PSA result which only show resurgence or that the hormone therapy is failing. My PSA has been <.01 since 6 months into hormone suppression.
I also have shifted my diet and take quite a few naturopathic nutritional supplements to try and stop any cellular metastisis.
I was in pain for a few days after the HDR due to the catheter, and they did give me some meds post-surgery for a couple weeks for bladder regularity after the stresses of the surgery, but it went really well.
Thanks for the response Sagewiz. It sounds like your treatment was a little more complicated due to the scheduling. I'm glad you came out of it with no serious side effects.
I agree that radiation is frustrating in not knowing if it worked for 2-3 years post treatment.
So very sorry for your diagnosis, but it sounds like there is a lot of light for you at the end of the tunnel. My husband also had G9, but no spread. But because of the high Gleason score, Dr. Scholz recommended the full arsenal except no surgery. Hormone therapy with Zytiga first, then the specialized brachy (UCLA's latest version) followed by EBRT. I know it's confusing and there are a lot of choices. One thing that really helped us make the decision on treatment path was getting a PSMA scan first to really really make sure there weren't tiny spots that MRI didn't identify. The Zytiga and hormone therapy had the most challenging side effects for hubby but I am pleased to say that a year and a half out from stopping the hormone therapy and Zytiga, he is cancer free and symptom free, and feeling fantastic! (4.5 years since diagnosis). We did A LOT of research (including this forum) before making the final decision. Sometimes he second-guesses himself ("Did I really need to be on hormone therapy that long?" etc.) but it seems to me there is more than one path to healing. I'm just so grateful that we're on the other side of this now. Keep visualizing yourself there, Cenerus!
Thanks very much for your very kind words of encouragement. The ADT so far hasn't been too bad, but I hear it gets progressively worse over time. I'm mostly concerned about zapping this cancer before the ADT becomes ineffective. I want an aggressive approach that maximizes the chance for a cure or long remission, but I don't want to do something that would seriously impact my quality of life such getting radiation proctitis.
Sounds like a good plan. As others have said, go hard and go fast in the beginning because it will pay off in the long run. You can endure any side effects because they are mostly temporary. The hardest part for the husband was the fatigue and weight gain/muscle loss. He did not work out consistently which he now regrets, and is making up for it. Everyone says to continue strength training and exercise as much as possible during treatment and I would say this is excellent advice, as much for helping your mental state as anything else, and then once you're able to quit the hormone therapy, you will have the habit already and see quicker results. As someone on this thread said, the triple-threat of hormone treatment with Zytiga or similar, high dose brachy and targeted radiation has the best outcomes for cure than other combos. That said, each situation is different. Keep us posted!
Very helpful thread! Thank you all for your input. I am shy of a year on my diagnosis and four months out of radiation treatments and striving for the best. Fatigue is my major bugaboo but trying to be petient and build up stamina to start an exercise regimen.
One caution about radiation. I had a fantastic team and have much less SEs than I have heard others on this forum recount. However, the SEs start appearing after about 2 to 3 years and probably around year 5 you might say the worst is over.
Thanks very much. That’s what I understand about radiation. Essentially the opposite of surgery as far as SE’s go. HDR Brachy appears to have more potential for certain side effects than straight IMRT, but a high success rate. I’m trying to balance both.
Hi, Had IMRT with HDBT boost 14 years ago. Side effects were minor and at least 8 other men in our PCa support group had the same treatment with virtually no side effects. The main advantage to the BT treatment is that it places a precise radiation dose directly into the prostate not beamed through your body potentially affecting bowel, urethra etc. Also the treatment eliminates movement of the prostate during treatment. Typically it would be 1-2 treatments not 5 or 45. Best luck with your difficult decision. I am available to discuss treatment further if you wish.
Thanks for the info. That’s my understanding. Seeing as I have pelvic lymph node involvement. The radiation to the lymph nodes will need to be higher, so the idea of having the highest dose radiation focused internal to the prostate seems to make sense to me as it lowers the overall GY’s spraying OAR’s like the rectum.
I cannot speak to radiation treatment. I was advised against it in favor of chemotherapy.
I have had RP surgery. I have had a chemical resurgence in the lower abdominal lymph nodes. I went from < 0.1 to 0.29 in less than 6 months post RP.
I was advised that triplet therapy, Lupron, Taxotere, and Zytiga would afford the best chances for longevity.
After my first Lupron shot and two Taxotere treatments my PSA returned to < 0.1 and has remained there.
I have completed six Taxotere treatments, (one every three weeks) and three Lupron shots thus far. I am now on Zytiga and prednisone daily... I'm heading for my fourth PSA test end of April...
No metastatic spread to bones pre and post RP. Current diagnosis: Prostate Cancer Ductal Variant, Stage IV. Gleason score 8.
Thanks for sharing your treatment. I had one MO that I interviewed recommend that course of treatment. Dr Mark Scholz of PCRI recommends that treatment plus brachy boosted IMRT for people with spread to the lymph nodes. On an emotional level I like that “guns a blazin” approach, but it seems like he’s in a minority of oncologists with regard to being that level of multimodal. But the concept of hitting the prostate and lymph nodes hard, then using chemo to attach undetectable distant micrometastasys seems very logical to my engineer brain.
The more I think about it, the Chemotherapy is an overall bodily treatment. It doesn't care where those little bastards are hiding or what they may be clinging to... it makes the rounds killing those little bastards off as it goes....
The Lupron starves their food supply and the chemo circulates around and hunts them down and cuts their little starving heads off.
I had days in-between chemo were I was capable of super human feats... Nothing could or would slow me down... it was as if as the cancer died I became more alive!
These are post reflections on my chemo experience... Once every three weeks for about an hour in the chair getting "juiced"
My chemo symptoms were moderate, first and energy boost, then a chemo dip, tiredness that did not resolve with rest for a day or two, then it was balls to the wall again until my next "juicing". My last one was on Valentine's Day of this year...
My primary side effects were diarrhea, and my hair fell out. Never had vomiting or chemo induced neuropathy.
I turned 69 this March. I'm a type II diabetic, and a heart attack survivor with a quadruple bypass surgery under my belt.
I live by the moto:
"You can't kill me motherfucker!"
My hair is coming back, albeit I look like a chia pet as it does... 😱...😆❗
I was PSA 30, Gleason 8 stage 3b but with no visible mets.
I completed 23 sessions of EBRT on 15th March followed by HDR brachytherapy on the 18th, I've also been on Prostap since July 2023
My Consultant said he normally likes a week or two between these procedures to allow patients to recover but pressure on resources determined there was an opportunity to get this done and dusted quickly so we went for it.
It's now been nearly two weeks and I'm slowly recovering,
The brachy was no problem as I had a spinal anaesthetic. The most painful bit was having the catheter removed the next day.....ouch!
The brachy is carefully planned by the consultant and his team after a CT scan of the prostate.
The senior consultant then places all the tubes in the various positions that have been decided, I think this is the part where the skill and knowledge of the team is important.
After this the radiation is applied automatically by the brachy machine .
My consultant said he was aiming for a curative treatment and was fairly confident of achieving this.
The effects of these cumulative treatments on my body have been pretty unpleasant, I don't really feel confident enough to go out unless I plan where all the toilets are, radiation has pretty well stalled the normal peristalsis but as soon as I get up and go for a walk this seems to quickly have the same effect.
Urinary issues are improving from being painfully up and down 5-6 times a night to now having periods of 2-3 hours of sleep, all this is par for the course and will improve over time....hopefully.
Getting to your question about the treatments, I have been guided by the experts, it's what they are there for, however as with all these treatments a lot depends on the skill of these people, as with all professions, there are different levels, but generally they are all very competent.
Thanks Tunybgur for the details on your procedure and SE's. It sounds like the post treatment recovery is definitely meaningful and requires a while to get back to normal. Good luck with the rest of your recovery.
Tall_Allen gives good advice on this forum and he made a suggestion to me to look at IMRT and HDR Brachy with ADT. I ran this past my RO and he believes it to be a good treatment plan.
So I started ADT 2 months ago (early Feb), - I initially had 2 weeks of Cassodex, then a 1 month injection of Eligard and then a 3 month injection of the same on March 14th. I left for an overseas 8 week holiday on March 27th and have so far had minimal SE's. Walking at least 5KM a day so far and not feeling too bad at all. A few hot flushes happening but not that bad (yet) - heading to Finland, Turkey, Italy, Spain, Cruising the Med and the finally Israel (Hmmmmm - probably more dangerous than PC)
Then when I get back I have the Gel inserted, have an MRI and Cat Scan all done mid June and then begin 23 sessions of IMRT. 2 weeks after that sometime late July or early August I have the HDR Brachy. Then at least another 6 months ADT. Going for Curative. RO and yes even my Urologist both say a good plan.
So in conclusion I think what you are doing is pretty well exactly what i have started out on.
All the best - but just see if Tall-Allen weighs in on this chat. He knows his stuff.
Thanks very much for sharing your details Mike. Your cruise sounds amazing, which cruise line is it on? My wife and I are also cruisers. Regarding your treatment plan, that's encouraging. I'm on Eligard and Abiraterone as well. So far just a few hot flushes and a little extra aches. I've changed my work out regime to increase weight lifting to help retain muscle mass.
However, one thing that I've noticed in the replies and in most studies I've fund is that nobody so far who has undergone Brachy boosted IMRT was node positive like I am. In every case so far the PC was confined to the prostate in PSMA-PET scans and MRI's. I have multiple positive nodes and that may make a difference in how the radiation needs to be delivered. There aren't a lot of studies of using brachy boosting on metastatic PC that is confined to the pelvic LM's like mine is, so maybe I'm a trail blazer. I'm going to meet with my original RO and discuss it with him and see what he has to say.
We have been long time diamond plus cruisers with Royal Caribbean. They are a pretty decent outfit. As far as your pelvic lymph nodes pc, - well I may be in that case because 6 months have past since I had my PSMA scan and although clear back then, who knows where I am now? This is why my RO is going to zap those as well, just in case.
Like you it was a big shock to learn all this initially, but now that I've settled for a treatment plan that seems pretty right for me (you seem to be on that same path), and because the ADT hasnt really had a major impact on me yet - I've settled into a pretty positive mind set about it all and with a very supportive wife and large family, we are goind to be as positive as we possibly can be. Guys with similar DX as you and me are still with us 20+ years after DX, so thats a positive in itself.
I was interested in your comments about your "extra aches" - I've had a few extra back aches as well and naturally you start to think - oh no, its spread to the spine. But in looking at Mets in the spine vs general muscle strain and back aches, the pain seems very different and what I'm currently experiencing is quite mild and only seems to happen when I stretch. I feel nothing when asleep at night or sitting. Only when i move awkwardly but even then it is a mild pain. Not sure if this is what you are experiencing or not?
Anyway, keep the course. You are not alone and keep in mind that many thousands of fellow sufferers dont ever use forums because they breeze through this trial reasonably easily and unscathed. I joined up because there is so much to learn on this site.
I'm diamond on Royal Caribbean and my next cruise will almost put us at Diamond Plus. The aches are more muscular than joints. I have had lower back pain for years that's a pinched nerve and some sciatica, so I don't worry too much about that. My PSMA PET/CT showed only the pelvic lymph nodes lighting up, so I'll assume no bone spread until something proves it. My goal with the cancer is to be aggressive early, so the interest in brachy boost.
Well then all the very best moving forward. I think IMRT and HDR brachy boost combined with ADT is a good path to take. Not a lot of difference between Diamond and Diamond Plus - Just a couple of extra free drinks and some free laundry. Don't give up going on holidays - they are great distractions for mind, body and soul. 😊
Wow, - The Icon of the seas, that is a ship we hope to experience at some stage. Yes it will be a great distraction for you. We hope you absolutely enjoy your time onboard. All the best.
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Anyone had High Dose Brachytherapy?
Should our RO's be doing HDR for Gleason 9?
HDR Brachytherapy after initial RT 
High-Dose-Rate Brachytherapy combined with External Beam Radiation Therapy.
