hdr brachytherapy or proton for salvage tx

[Tommyj2]

MSK RO (Gorovets) recommends proton sbrt due to my preexisting urinary issues….hdr brachytherapy logistically is a LOT easier for me…..wondering if anyone here has any experience or opinions on this topic…..with all the hype about proton therapy and few studies to back it up definitively I’d hate to be directed into a tx that has no appreciable advantages because the hospital needs to make back the cost of a multimillion dollar machine…….had an overall good feeling about Dr. G any thoughts?

[God_Loves_Me]

I had SBRT using proton therapy in past. There are some side effects as well but mostly smooth experience

[Tommyj2 in reply to God_Loves_Me]

Glad it went well for you…..was proton sbrt your only tx? Was it curative? Thinking not if you are on this forum…..what SE’s? How are you doing now?

[Tommyj2 in reply to God_Loves_Me]

Sorry…asked questions prior to reading your profile….sorry for your situation……no need to respond.

[Sagewiz in reply to God_Loves_Me]

The same with me. From my research, the skill of the physician with the technique is more important of a factor than the tech.

[Tall_Allen]

This is for an intraprostatic recurrence? You can get just one or two HDR-brachy catheters and put the radiation only where its needed with very little toxicity to surrounding tissues. Whereas proton SBRT (Whole gland or focal and what dose?) may or may not give you the same precision and the same magnitude of cancer-killing dose

[Tommyj2 in reply to Tall_Allen]

Hard to call it a recurrence when they never really got all of it the first time round…..but…it IS confined to the prostate and the tx would be focal i am presuming as there is only one area in the prostate that appears to be responsible for continued rise in psa. What is confusing me is that the RO specifically stated that he believed I would have less urinary toxicity with proton tx….he is expert in both hdr brachytherapy and proton rt and can offer either but suggests proton…….i think I need to ask him specifically why proton would have less urinary toxicity than hdr brachytherapy when it appears to me that hdr offers more control over where radiation is applied…..im missing something.

[Mike58 in reply to Tommyj2]

Hi.

I’ve recently had HDR Brachytherapy and the SE’s so far are manageable. However here in Australia they do some pre- checks before they will treat you with HDR -B and one of their most important check’s is your current urinary flow. If you can’t pee at a prescribed level you will not be a candidate for the treatment. I’m guessing this is because HDR can play long term havoc with the urinary tract and so if yours is already compromised then it’s best not to aggravate it any more.

Hope this helps. All the best.

[Tommyj2 in reply to Mike58]

This is really good to know…..I clearly am having problems with urine flow…….i thought that HDR could be tailored to avoid damage to the urethra but it appears it has its drawbacks as well…….

[Xcrunner1988]

Hi Tommy,

I don’t have any experience with Proton, but have had HDR and Salvage Brachy.

13 months past salvage and PSA is at 0.1. No urinary issues. No change to sexual function. No bowel issues.

Feel free to ask away if there is anything I can answer for you.

[Tommyj2 in reply to Xcrunner1988]

Where was this done? Did you have the catheters and needles or seeds or both( it says you had hdr AND salvage brachytherapy)…..thanks for weighing in on this.

[Sleepyeye1911]

brachytherapy only worked for me two years and failed. Lupron injections prior may have helped. Radiation precluded treatments in the future. No treatment is foolproof.