My husband made his treatment decision today. After a lot of research, questions and consults, he has decided on brachyboost (EBRT plus brachytherapy) plus 6 months of ADT. It was a tough decision and we both know way more about prostate cancer now that we ever wanted to, but I am glad we did our due diligence. Thank you to everyone who encouraged us to take the time to look at options and thank you for all the support getting through the last two months.
Now we move forward and hope for the best outcome, and try not to look back. It’s hard because you want guarantees, but there are none. We’re both on the same page with this and I hope he gets through it without any long lasting side effects. Thanks again 🙏🏻
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EvFC
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Brachytherapy is a good choice and you’ve caught it early in the game. With GL-9 you may want to consider longer term ADT, and follow-up with pelvic radiation (IMRT), just in case. Your PSA a few months after Brachy may be the determining factor. I had HDR-BT/IMRT 5 years ago with little SE’s (see profile).
Thanks for the feedback. Brachyboost is a combination of EBRT and brachytherapy, so he will be having both. Hope my husband will have few side effects too. All the best!
I think what timotur was getting at is that Brachyboost doesn’t necessarily mean the EBRT aspect is radiating beyond the prostate itself. For higher risk cases there is the option for the EBRT to include the whole lymph/pelvic area to quell any undetectable cancer cells that may have spread to lymph nodes- the first place PCa usually goes. If you google “MSK nomogram prostate cancer”, you’ll find a personalizable calculator that will give you the approximate risk for recurrence for your husband. Generally, if the risk is above 15%, pelvic radiation should be considered. And I imagine 4+5 is going to be much higher than that. I was right around 15% at 4+3 and my very high decipher score tipped me toward full pelvic radiation. You have one chance to hit it strong from the start and hopefully avoid life-long ADT. I’ve seen a few studies over the last year or so showing 12 months ADT seeming to be the sweet spot if you’re having Brachyboost for contained high-risk (as opposed to 26 months for standard EBRT). I chose one year Orgovyx and Nubeqa myself (28 days left!) It’s definitely manageable. Best of luck to you.
Thank you for clarifying. Our radiation oncologist had explained to us that the benefit of brachyboost was that the EBRT would target a wider area beyond the prostate and the brachytherapy targets the prostate itself, which is advantageous with high risk prostate cancer. I thought that approach was standard for brachyboost, but from what you’re saying I guess it’s not in all cases.
Thank you! Are you also on Reddit? I think I have been trying to encourage your husband to consider radiation over there, because of his high Gleason and decipher. I understand that he is adamant about surgery and in the end know it’s his choice. My husband felt that way initially, but came around as I shared more and more evidence with him and after we spoke with the oncologist. Hoping for the best with his current treatment. Wishing you both all the best!
I took a break from posting for a while, because I was feeling worn out from all the research! Things are going well so far. My husband started Firmagon back in May. He’s had four shots so far. He has some side effects, but nothing that is setting him back too badly. He kept up his running and I think that really helps. His PSA dropped from 5.9 to 1.4 after he started the medication, so that was a good sign. Because the oncologist decided to start with the brachytherapy rather than the EBRT as initially planned, he has to take a bit of a break between the two. That means he’ll have to be on the ADT for an extra 2-3 months.
He had his brachytherapy surgery on Aug 6 and the oncologist also put in a spacer. After that surgery he had some burning when he peed and a bit more urgency, but that seems to have levelled off now. He wakes up at night to pee more than before, but that’s his main side effect. Side effects can be delayed with radiation, so we are hoping nothing new pops up.
We are expecting his daily EBRT to start the week of Sep 23. Hoping that will also go well. He won’t really know how it’s all working for a while, as testing for PSA after radiation isn’t as clear cut as after prostatectomy. So far things seem to be going well though.
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