MRI prior to HDR Brachy and HDR intensity.

[Mike58]

Hi Friends,

Hey, I'm doing well to date in coping with HT and have just had 10 of my 23 VMAT radiation sessions. So far so good. BUT recently I was told that the radiation sessions are nothing compared to the "Brutal" HDR Brachy Boost I am having in mid-August.

That wasn't what I wanted to hear, so my question is, - Is it unreasonable to request an MRI at the end of my normal radiation treatment to see how the PCa has responded so far?

What if the MRI shows that the PCa has reduced significantly in size and is in actual fact "dead" and if such a diagnosis could be made, wouldn't it be best to forego the HDR Brachy? Why endure a so-called brutal treatment if it is not warranted or will be of no extra benefit?

I'm kind of expecting the answer to be, - to run with the plan and I'm not at this stage going to deviate from it, but another question is, - Can the HDR (High Dose Rate) be tempered a little to maybe not make it too intense as to cause other health issues? Does anyone know what the intensity is going to be as a standard? I'm currently getting 42gy sessions of radiation.

As always I appreciate your wealth of knowledge. Keep fighting.

[Tall_Allen]

You can't tell anything from a scan. The HDR boost is a strong dose of radiation to the prostate in order to be curative. The side effects are the same as if it were external beam.

Here is what you can expect:

prostatecancer.news/2018/10...

[Mike58 in reply to Tall_Allen]

Thanks TA. Do you happen to know what the GY level is of HDR Brachy? and is it something that can be played around with as far as intensity goes?

Also from what you have said, it sounds like it is a waste of time getting an MRI, even though it was an MRI that detected the PC lesions in the first place. ?

[Tall_Allen in reply to Mike58]

As I said, scans will tell you nothing at this point.

The brachytherapist knows what he is doing. I know you are anxious, but resist the urge to tinker. You do not know the first thing about radiobiology.

[Mike58]

Arrrrgh. Thanks TA. You will aways allay the anxiety and yes I will learn to put my confidence in the medical professionals and not on my own sometimes out of kilter reasoning. 😜

[timotur]

Mike, I think you’ll find the process of HDR-BT is very tolerable, almost as easy as getting a colonoscopy. Mine was done five years ago by Chang at UCLA, and it was a one day procedure, in by 7am, out by 3pm. I had minor short-term effects— the first day, a little soreness around the perinium and burning sensation while urinating, the first week, some incontinance where it felt like the bladder wasn’t empty after urination, but everything is normal since then, no long term SE’s, with normal urination and sex functions. The procedure sounds worse than it is, and I was trying to talk myself out of it leading up to it. Trust the process, it’s a very good treatment option.

[Mike58]

Thanks Timotur, a great confidence boosting answer. Very much appreciated. it looks like your leading a pretty normal life now. That’s great. Free of all treatments by the looks and for a few years now. Well done.

[dude69]

Hi, had my 25 EBRT followed by HDR Brachy in Sept. Not brutal for me. An experience for sure but like other comments you are under and like a colonoscopy. I was out for 4 hours..woke up with a catheter and had it for a day to secure everything was working. Was over night at hospital then the next morning they yanked the catheter out. Then I walked home 2k. Today still on hormone therapy. I get a pamorelin shot every 6 months to kill the testerone. Have 2 more left..PSA not measurable and they consider me cured but who ever knows.. Exercise every day and a runner. Was a 43 min 10k runner when this all started but now 49 min...loss of testerone probably reason for slow down but who cares i am alive and live for the day and the moment. thankful for every day...we dont know what tomorrow brings so excercise, enjoy the beauty of the world and the moment and brachytherapy will just be another event in a day...best of luck...

[Mike58 in reply to dude69]

Hey dude69, sorry I missed answering your reply to me. I'm very impressed with your fitness level while still on HT. I am somewhat confused about you saying your PSA is undetectable, because from what i can gather if you still have a prostate, that it will always produce some PSA regardless of HT and RT. My PSA is currently 0.27 and after brachy may lower to 0.2. My RO said that such a reading is probably the lowest it will go.

Anyway, keep on running mate. Your doing well.

[dude69 in reply to Mike58]

Psa undectable for now..<.10 psa last measurement. Get measured again next week. My doc said with treatment I have received can stay there or go up to 2 before they do anything else. Like I noted 2 more pamorelin castration shots to stop testarone. One day at a time being thankful for every day..Best of luck on your journey

[TTJJ1]

Just wanted to respond to your inquiry about Brachytherapy. Short version of my history.

Being treated at Dan Faber in Boston, MA, USA

TX in 2017, Gleason 10. Had daily external beam for 5 weeks, followed by Brachytherapy (40 seeds).

The procedure was not Brutal at all. There was some discomfort that day and the next day, but very tolerable without any pain meds. Frequent urination for several months. Fatigue was very tolerable. No incontinence and did not need catheter once out of surgery. Within a few weeks I was back to normal and went back to daily 3 mile runs about a month after. (Exercise will be very important as part of your fight with this cancer)

One very import factor to consider is the spacer between the rectum and prostate. I would highly recommend that this spacer be placed along with the Brachytherapy, it protects the rectum from the radiation seeds in the prostate. You should discuss this with the radiologist that will perform the Brachytherapy seed implant.

Please do not hesitate to reach out if you have any question.

I wish you all the BEST.

[Mike58 in reply to TTJJ1]

Hi TTJJ1,

It sounds like you had LDR Brachy which is different to HDR Brachy. With HDR they do not insert low dose radioactive seeds but rather they just pound the tumor with a High Dose Rate of radiation right next to or into the cancer. It is a once off treatment that only lasts for seconds. The tricky part is getting the probes to be as close to the cancer as possible and hence the proceedure can be as long as 3 hours. They put you out to it.

I hope your treament continues to have a long term satisfactory outcome for you and keep up the fitness regime.

All the best.