What questions should we ask re brachytherapy boost?

[EvFC]

Hello, we are trying to get an appointment with a radiation oncologist to ask about brachytherapy boost as a potential alternative to RALP. What questions should we ask when we talk to her? Thank you!

[RyderLake2]

Hello,

How often have you done this procedure?

[Tall_Allen]

Here are a few:

HDR Brachy Boost doctor questions

1. What is the protocol? EBRT to pelvic lymph nodes - how high? Brachy boost to the prostate - after/before? What dose? What duration ADT? Any other hormone therapy?

2. How many BBTs have you performed? Does a different RO do the external beam?

3. How has your practice of HDR brachy boost changed over the years?

4. What is your 5-yr freedom from recurrence rate for patients at my risk level? What proportion of your recurrences were local?

5. What kind of urinary and rectal reactions can I expect? How long can I expect them to last? What medications or interventions do you typically give for that? Should I expect those symptoms to recur later?

6. What is your rate of serious (Grade 3) adverse events? Do you see urinary strictures? Urinary retention requiring catheterization? Fistulas? Rectal bleeding requiring argon plasma or other interventions?

7. Number of insertions? Number of fractions? Dose per fraction? Expected time in hospital/doctor's office?

8. What is the prescribed dose to the planned target volumes?

9. Do you recommend SpaceOAR in my case?

10. What kind of imaging do you use for planning? MRI? CT? US?

11. Do you increase dwell times in areas of known cancer?

12. Do you use fiducials or Calypso transponders?

13. In my treatment plan, what do you identify as “organs at risk” and what dose constraints do you put on them?

o What dose will my penile bulb receive?

o How do you limit urethral dose? (e.g., catheter)

14. How long does each treatment take for EBRT?

15. How will I be immobilized/anesthetized during each BT treatment? What kind of analgesia is used?

16. Are there any bowel prep or dietary requirements?

17. Should I avoid taking antioxidant supplements?

18. In your practice, among men who were fully potent, what percent remained fully potent 3-5 years later?

o Have any men retained some ability to produce semen?

o What is your opinion of taking Viagra or other ED meds preventatively?

19. Do you monitor side effects with the EPIC questionnaire?

o In your practice, what percent of men experience acute urinary side effects?

o In your practice, what percent of men experience acute rectal side effects?

o In your practice, what percent of men experience late term urinary side effects?

o In your practice, what percent of men experience late term rectal side effects?

20. What kind of PSA pattern should I expect following treatment?

21. What is the median PSA nadir you are seeing in your practice, and how long does it take to reach that, on the average?

22. In your practice, what percent of men experience biochemical recurrence?

o What % of those have been local?

o If there should be a biochemical (PSA) recurrence, what would the next steps be?

o Have you ever used SBRT, brachy, or cryo for salvage after a local HDR brachy failure, and was that focal or whole gland?

23. Are you open to email communications between us?

[EvFC in reply to Tall_Allen]

Wow! Thanks so much!!

[timotur]

I had HDR-BT five years ago, and here's what I would ask knowing what I know now:

- What is the timing of ADT before the procedure (I did two months prior, Lupron/Zytiga)

- How many times have you placed SpaceOar? (You want a doctor that has done this dozens of times. I had it and recommend it, just had a colonoscopy and verified I have no radiation proctitis 5 years post procedure)

- Will you treat any external structures such as the SV based on the PSMA scan? (I had SV involvement on the left side, and he treated both SV's as a precaution)

- Do you recommend IMRT pelvic radiation after BT? (This will partially depend on your PSMA scan. Typically it is done about six weeks after BT. I had 25 sessions of ~1.8Gy)

- Will a cystoscopy be done to look urether/bladder involvement?

- What SE's are most common? (Usually it's burning urination the first day or two, and urinary retention the first two weeks. I had both. Also, some oozing in the perineum the first few days).

Good luck!

[EvFC in reply to timotur]

Thank you! Can I ask what your Gleason score was going into it? Would your procedures be considered HDR-BT with EBRT and ADT? (Sorry, maybe an obvious question, but I am still learning about all of this!). How long were you on ADT? Just the two months prior to radiation?

[timotur in reply to EvFC]

Yes, it’s considered HDR-BT/IMRT/ADT. I was on ADT for 18 months total. I started at PSA 33 before treatment with GL 3+4, t3bN1M0+SV advanced PCa. Details are in my bio.