Brachy boost question

[Cafu6]

Hello,

My dad has been on ADT for ~6 months. All is going to plan at the moment and he had some recent tests to determine when to start radiation (we were thinking this November to keep the ball rollin’).

His recent PSA is down to .09 (from I think like 12 back in January 2024). CT scan shows cancer in the prostate and the prostate has shrunk considerably in general (down from 5.4cm to 4.2cm). His pelvis lymph node (where there was some cancer), the CT reported “no adenopathy”; however, radiologist mentioned there is a very trace amount still there. The original CT scan (from January or February 2024) read “Seminal vessical invasion. ECE. One lymph node”, so certainly an improvement this scan.

My question for you wise folks…

we were told that Brachy boost still won’t be an option because of the lymph node (eg external involvement). Has anyone been successful in obtaining brachy boost first, followed by pelvis radiation with lymph node/external involvement? We were hoping to go to Sunnybrook or Princess Margaret in Ontario, CAN.

Thank you in advance.

[Tall_Allen]

It doesn't matter which you do first, if that is your question.

[Cafu6 in reply to Tall_Allen]

No my question is: did anyone have success in getting brachy boost even with lymph node involvement / external involvement? We were essentially rejected because of lymph node involvement.

If there is other places Canada or US who still treat with external involvement, we’d like to reach out to them. Thanks!

[Tall_Allen in reply to Cafu6]

A friend with positive LNs had HDR brachy boost therapy at UCLA. Kishan did the external beam part, and Chang did the HDR brachy part.

[j-o-h-n]

Hello Cafu6,

If possible please update your dear Dad's bio. Info there helps him and helps us too. Thank you!!!

Good Luck, Good Health and Good Humor.

j-o-h-n

[Proflac]

My husband (UK) had HDR brachy prior to EBRT and he had 1 positive lymph node on regular CT scan.(Not PSMA scan in those days). Dr. Said it would give maybe 10-20% chance of a cure. Sadly this was not the case but he is still here 7 years on, so maybe it had an impact. Impossible to know. It was a very straightforward procedure. That said. We had to press for this as it wasn't on offer at our hospital. Might be a case for another opinion as clearly practice varies on this one.

[timotur]

Cafu: yes, I had HDR-BT followed by IMRT five years ago and still holding at near nadir PSA at 0.02. I had one possible LN (mesorectal) along with SV involvement, Stg 3b. (See profile). I actually think it’s better to have Brachy first, followed by IMRT, because the area with the highest concentration of PCa in the prostate is treated first with Brachy.