HDR Brachytherapy

[Jimbo47]

I'm going in for my 2nd HDR Brachytherapy treatment tomorrow at UCLA. If anyone wants to share their experience about their HDR Brachytherapy treatments with me or ask me any questions about my experience, feel free. I did a lot of research on the various options and talked fairly extensively with medical professionals before I chose this treatment. However, I haven't communicated directly with anyone else that has actually experienced HDR Brachytherapy for prostate cancer. Probably something I should have done ahead of time.

[no5ole]

Hi Cruiser,

Had HDR 11 Jan 2018. Other than the prep, things went fairly well. My body doesn't like having holes punched in it so there was some soreness and expected blood in urine.

A little touchy the next day, but workable.

Had more issues from the Lupron and 25 external treatments than from the HDR.

Right now, just waiting for the ADT sentence to be finished (Dec 2018) then see what comes back next year for 'T'. I had 5 '9's' and 1 '8' Gleason. Was not interested in surgery. I know I made the right choice for me. Now time will tell for the cancer.

Good luck and God Bless,

Rich

[Jimbo47 in reply to no5ole]

Thanks for your reply. More needles for me tomorrow. Then hopefully the worst is behind me. You've got some major stuff ahead of you but I can tell you've also got the right attitude.

Best of luck to you

Jim

[AlanMeyer Moderator]

I had treatment with Lupron, then 2 sessions of HDR brachytherapy separated by 25 sessions of external beam radiotherapy for a Gleason 4+3 cancer that had penetrated the prostate capsule wall. The treatment was at age 57 in 2003 and early 2004. I have not had any treatment at all since then and my current PSA is 0.07, so it appears that the treatment was a big success.

I did have a lot of "PSA bounce". The PSA went up (as high as 1.8 in one test) and down in alternating cycles and it took five years to settle down below 0.2. I was told that it was because the radiation does not kill the tumor cells all at once and, while they are surviving in a damaged condition, they can put out more PSA than usual.

My principal short term side effect of the HDR (there were others from the Lupron and the EBRT) was difficulty urinating. I was able to survive without a catheter, but I needed tamulosin (Flomax) to be able to urinate at all. Because I couldn't squeeze out much urine at one time, I had to urinate frequently, about once per hour - which was a sleep disruptor. That was very bad for two months and then gradually got better until, after five months, I was able to get off the Flomax.

My principal long term side effect was impotence. It took about five years to reach the point where my erections, such as they were, were no longer usable. I didn't like that but I didn't like cancer even more and my wife and I have adapted and have, if not a typical sex life, at least a still very enjoyable and satisfying one.

Good luck with your treatment.

Alan

[tsim in reply to AlanMeyer]

Alan, could I ask how long you were on ADT and were you N0M0? It sounds as though we're close to same dx Trying to determine length of ADT time, I want to hop off at 18 mos. but MO and RO keep throwing the dart toward the 24 MO.spot.

Tom S.

[AlanMeyer Moderator in reply to tsim]

This will sound dumb from someone who gives advice to others, but I don't know all of the details of my pre-treatment condition. At the time, I knew almost nothing about prostate cancer, never asked for any documentation (like the biopsy report), and wouldn't have known what it meant.

Here's what I do know:

The Gleason score was 4+3. Clinical staging was T2c. I don't know what the node staging was though they did show me an MRI image and pointed out a tumor that extended through the prostate wall and into surrounding tissue. They told me that there was a significant chance of prostate cancer in tissue near to the prostate and that they were going to radiate an area one centimeter around the prostate with 3DCRT. I don't know how many, if any, lymph nodes were included.

I was given two injections of Lupron. The first was a 30 day injection. After the 30 days, they took various blood tests and gave me a 90 day injection. A few days after that they got the results back from the blood tests and discovered that I had highly elevated liver enzymes - which they believed to be a dangerous condition caused by the Lupron (it is a known side effect in some patients.) They thought it would be a bad idea for me to take more Lupron but there was nothing to be done about the 90 day injection except wait it out. If I remember correctly, it took about five months for the testosterone to begin to return and hot flushes to stop and another month before I felt like I was back to baseline conditions.

Do your docs have actual data for 24 months vs. 18 months? Or are they doing what normal humans do - which is to urge people to err on the side of too much caution rather too much than risk?Here's an article, I think I first saw it in a posting by Tall_Allen, that says 36 months of ADT is not better than 18, but I don't know whether that would be true in your case.

In the end, of course, no one can give you an injection if you refuse to take it. So the decision is yours.

Good luck.

Alan

[tsim in reply to AlanMeyer]

Alan, thanks for the prompt reply, after reading a lot of your posts it sounds like you have increased your knowledge level greatly. You're spot on in the assessment, there is no data for 24 month duration. I have read the Nabid studies about 36 vs 18 month duration and that was my question to RO and MO, if 36 months is no better than 18 how is 24 month better. At least the MO had the guts to say there's no data to support that. So I'm stopping at 18. The hot flashes aside, I hope I can gain back the half of my muscle mass I lost and regain my once stellar memory and cognition.

Regards, Tom S.

[AlanMeyer Moderator in reply to tsim]

I can see already that your cognition is first rate :). You'll have to work hard and it will take a fair number of months, but I think you'll get everything back minus the little bit that we lose over time as we age.

Good luck with it.

Alan

[AlanMeyer Moderator in reply to AlanMeyer]

I referred to a study above but I see that I forgot to include the link to the text. For the benefit of others (tsim has already read the study) here's the link:

europeanurology.com/article...

Alan

[Bionicpenis in reply to AlanMeyer]

AlanMeyer if you don't mind me asking, what caused the impotence? I'm doing the 25 session beam treatment (IMRT) and a single HDR, no hormone treatment. My PC is still contained in the prostate but is right against the capsule wall and starting to bulge out. 3+4 G7

I was told that ED effects wouldn't be noticeable until likely 10-15 yrs from now (I'm 51) when it seems to happen naturally anyway.

[Fauvemarin]

HiYa CaCruiser - I am on the East Coast (Massachusetts) and am intrigued that you are one of a series of West Coast folks that I have seen treated with HDR brachytherapy, yet as far as I can tell, this is not a procedure utilized here. Neither Johns Hopkins nor Dana Farber include this as one of their recommended therapies. Here brachytherapy involves implanting radioactive iodine seeds in the prostate, basically in the same manner as prostate biopsies. Pretty much an outpatient procedure with minimal side effects (other than dealing with the radiation). I had this procedure, and was pretty much ready to go back to running the next day.

If UCLA Med is using this therapy, then I am sure it must be good, but it is interesting that the two coasts seem to have diverged on brachytherapy.

Did your oncologist ever discuss seed implants?

[Jimbo47 in reply to Fauvemarin]

As far as I know UCLA only does HDR brachytherapy and surgery. My urologist is at UCLA and after the biopsy he recommended that I consult with a surgeon and the radiation oncologist who does HDR brachytherapy then make my decision. I had my last brachytherapy treatment on May 31. I think its all going well but I wish I had found this site before making my decision on treatment. I pretty much got the UCLA perspective and nothing else. I didn't know there were so many other options. Now that I've read about other treatments I think I may have gone with Proton Therapy. However, no buyers remorse yet. Its interesting that HDR brachytherapy isn't as widely used on the east coast. I know that in addition to UCLA HDR Brachytherapy is done at Cedar Siani, USC, UCSC, Stanford, and University of Washington. There may be others. I knew that LDR Brachytherapy (seeds) existed before I made my decision but read that occasionally a seed will go rogue which isn't good.

[Fauvemarin in reply to Jimbo47]

Interesting - but the occasional seed being passed doesn't seem to be regarded as an issue. Half life is 3 months, and the dosage of each individual seed is low

[Jimbo47 in reply to Fauvemarin]

That makes sense. Funny how all of these fallacies about the side effects of treatments are spread around. If you know anybody thats thinking about doing HDR Brachy and wants information from someone who has recently experienced it send them my way.

Jim

[Fauvemarin in reply to Jimbo47]

Will do. This is a good place to follow so you can act as a resource for others. A good team of Drs is essential but it seems sites like this are helpful in providing another source of info that you would not necessarily have in your local culture.

Got to be careful though to take some of the advice with a grain of salt, but by and large I have been impressed with the quality of advice from the folks on this site (I am a PhD level biologist, so in many cases I actually understand the quality of what folks are talking about).

Richard

[MackNelson in reply to Jimbo47]

Jim, I am about to do HDR Brachytherapy for prostate cancer in Detroit, MI. I would love to know what to expect and any information you can give me, would be greatly appreciated. I am finishing up 25 Proton Therapy Radiation Treatment today, in Knoxville, TN. My gleason score was 9. PSA 26. Would love to talk to someone, first hand that has done HDR. Thank You, in advance, for any information you can share with me.

Mack

[Longterm101 in reply to Fauvemarin]

Foxchase cancer center on Philly does HDR

[gto67]

I had HDR Bachytherapy in 2012 at St. Lukes Hospital in the Philippines. It was basically not really bad as treatment goes. I had very low Gleason of 4 and stage 1. Treatment was scessful as my current PSA is .53 lowest it has ever been. I refused Lupron as it has a 40% chance of causing colon cancer. My father had prostrate cancer. He was treated with Lupron and controlled the prostrate cancer but died of terminal colon cancer.

[Jimbo47 in reply to gto67]

My radiation oncologist never mentioned Lupron. My Gleason was 4+3=7, psa 5.2, and I'm Stage 1. What are the benefits of Lupron?

[PopCubby in reply to Jimbo47]

I just found this site yesterday and came across your post of 3 years ago just before your 2nd HDR brachytherapy treatment.

I am trying to make a decision this week between HDR brachytherapy or SBRT.

What has your experience been? Any regrets?

[gto67]

No benefit from Lupron except a 40% chance it will give you colon cancer if you tak eit.