Pretty Soon, I'm Having HDR Brachythe... - Prostate Cancer N...

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Pretty Soon, I'm Having HDR Brachytherapy

Arthro92 profile image

Hello, all. Pretty soon, I'm having HDR Brachytherapy. Is there someone out there who can counsel me on this procedure who actually been through it?

30 Replies

I've watched patients go through it. What do you want to know?

Arthro92 profile image
Arthro92 in reply to Tall_Allen

success rates, but mainly side effects soon after

Tall_Allen profile image
Tall_Allen in reply to Arthro92

For the monotherapy?

Arthro92 profile image
Arthro92 in reply to Tall_Allen

thank you, i will take a look at this.

I had HDR-BT with SpaceOar at UCLA with Dr Chang, and had virtually no SE’s. The process is basically, prep, anesthesia, cannula insertions (20) into the prostate, wake up, CAT scan to fine-tune placement, then finally insertion of radiation pellets for a short dwell time. Then removal of catheter, if you can pee, you go home. Was in at 7:30, out at 2:30 that afternoon, walked back to the hotel, then drove 100 miles back home the next day. Excellent treatment and results (see profile).

ocman profile image
ocman in reply to timotur

Hi, glad to hear things went well for you. Just curious, what insurance do you have that approved the SpaceOAR gel?

timotur profile image
timotur in reply to ocman

Thanks, I’m on my wife’s employer plan, Blue Cross/Blue Shield PPO option.

Where r u thinking of having it done

I just had HDR in philly with dr Horowitz.

Great experience.

Smart doc

No side effects

Arthro92 profile image
Arthro92 in reply to Longterm101

Emory Univ. in Atlanta, GA.

PopCubby profile image
PopCubby in reply to Longterm101

I am new to this site and just saw your post from 2 years ago about HDR brachytherapy with Dr. Horwitz. I just met with him last week and he recommended HDR brachytherapy for me.

Do you recommend it? Have you had any side effects? Any regrets?


Longterm101 profile image
Longterm101 in reply to PopCubby

No side effects

Great doctor

Really liked him

Happy to answer any questions u have just DM me

PopCubby profile image
PopCubby in reply to Longterm101

Dr. Horwitz is recommending 2 treatments without ADT. What did you have?

Longterm101 profile image
Longterm101 in reply to PopCubby


PopCubby profile image
PopCubby in reply to Longterm101

I see that some of the guys who had the BT used Cialis before and after the procedures to try to guard against ED. I plan to ask Dr. Horwitz about that in my case, but did he recommend that for you?

Longterm101 profile image
Longterm101 in reply to PopCubby

No he didn’t …

Hmm... I had HDR-BT without SpaceOar at MSK on April 26th. The hardest part was the mandatory voiding process (you have to pee a certain volume) before they let you go home. This is to provide some degree of assurance that there is no retention.

I was fortunate that my recovery only took 24 hours. However, I was prescribed an antibiotic (Levaquin) and after 48 hours, I awoke with a searing pain in my right Achilles tendon. I was limping in pain for 3 weeks. Mention this to your Doc!

In June, I had 25 days of IMRT, no problem.

I've been on ADT, now, Lupron, Zytiga and predinsone since march. Again, no problem.

However, I think that optimism and attitude are key to a successful outcome.

My dx was 13 months ago. G9, stage 3 and I feel great,YMMV.



brooklynb profile image
brooklynb in reply to westof

I had basically the same experience. Also G9. Had HDR-BT with Dr. Grasso and Dr. Ng in New York. 2 months later started 25 days of RT. Just had my first blood test. My PSA is 0, was 45(!) before treatment.

I went through it just over a year ago and found it to be far more manageable than expected. Pleasantly surprised by the non-invasiveness when compared to biopsy. Can you let me know more about what your questions are?

I plan to allow Dr. Moghanaki from Emory Univ. perform the HDR-BT. I'm not exactly sure if will be with/without space oar. My questions as of now are what were the SE's days after your treatment? How did you feel days after your last HDR procedure? What were your urinary symptoms, any pains that weren't there before?

westof profile image
westof in reply to Arthro92

Hmm... I was up and about the next day. I did, however, learn the meaning of incontinence! Ran to the bathroom and made a bit of a mess. Had I known, I would have bought some Depends. However, necessity being the mother of invention, I stuffed a t shirt into my briefs and that did the trick, The whole episode lasted about 16 hours and then went away.

Aside from loss of libido,etc. I've been free of SE's and I turn 71 in December.

Good luck. As is clear from the other replies, the experience varies very much from person to person. In my case, the operation seemed to go off without a hitch, but I could not pee without a catheter for many hours, and it was very uncomfortable not to say terrifying. A year later, I am still suffering from the opposite condition, extreme incontinence, as well as from impotence. And so it has not been a pleasant experience, athough my PSA has gone down drastically and, with luck, I may survive.

C, that's what frightens me, incontinence, extreme incontinence. i've been takin' casodex for 60 days and hope to have HDR BT pretty soon. i'm nervous about any urinary symptoms i may not be able to control.

Just had it in St Louis three weeks ago. Had one shot of lupron, 5 weeks of external, than the Brachy. Day after Brachy had burning when urinating, but that went away by next day. I have been having problems with retention (dificulty peeing) that Flomax is handling. I was told that it could last 4 to 6 weeks after brachy so I am waiting and hoping. Have had difficulty getting erection, but can ultimately (told that was from the Lupron, however) but cannot ejaculate... I'm assuming that issues causing restriction with urination are also impacting, but have not talked to doctor yet about this latest effect. That's tomorrow'ths phone call.....No other side effects so far that I can tell. Saw some other replies talking about incontinence, but everything I've read is that difficulty, rather than the incontinence, is the usual SE in that area, if any

Arthro92 profile image
Arthro92 in reply to StLouisGuy

would you recommend HDR-BT?

Cant really say yet, cuz don't have the results as to whether "got it all" or not. First true follow up is 10/17 and even then any good news will be tempered by fact that still within the window of my Lupron shot, which will independently depress the PSA reading. I chose the radiation approach over surgery because after a fair amount of reading and research, and seeing two surgeons and two radiologists, I was convinced that the prognosis under either approach was about the same (and good), so it became a question for me of choosing by which side effect platform I'd be more able to withstand. Incontinence was reported by all as a possible SE from surgery, whereas urinary difficulty was the possible SE from radiation, and there are alot of other pluses and minuses on the SE side when comparing the two. Ultimately, for me, I decided I'd rather risk retention than incontinence, believed that for my situation, either approach had a 90%+ chance of success, so opted for the radiation. Once I did that, both radiologists I had been considering recommended the same course of treatment: Lupron shot, 5 weeks of external radiation, then Brachy HDR, so I frankly didn't really investigative alternative approaches within the radiation spectrum. I have been lucky so far, with minimum SE from any stage of the treatment, except for some sexual disfunction starting with the Lupron, and some urinary restriction about three weeks into the external treatments and continuing post Brachy. If the PSA readings are good and it turns out that it looks good, then I would recommend the Brachy based on the above, if your view of the side effect weigh out question is the same as mine. ALSO, the effectiveness and advisability of approaches varies by the extent of your situation, so read what you can, and talk to as many people as you can, and try to see through the "surgeons want to cut" and "radiologists want to radiate" nature of perspectives and advice. In my case, one of the purported top surgoens in St Louis was the one who said that he was more than willing to perform the surgery, but given the equal chance of results in my situation, suggested I consider the side effects question and specifically the urinary issues, and clearly was indicating he would do the radiation despite being a surgeon -- a rare bird.

Arthro92 profile image
Arthro92 in reply to StLouisGuy

yes. a very rare bird. thanks a lot. i was given a lot of the same advice you were given with respect to the prognosis and the potential SE's of either procedure.

Be prepared to post here more often..

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 09/30/2019 5:19 PM DST

AlanMeyer profile image

Sorry I'm late with this. I just now saw the post.

I had two HDR brachytherapy treatments in 2003-4, with 25 sessions of external beam in between. I had a number of side effects - some bleeding for the first week or so, and hard pain during orgasms and blood in the semen, for some weeks after the treatment. The biggest side effect was inflammation of the prostate that made urination very difficult and almost impossible without Flomax. That took about 5 months to resolve.

I suggest putting the term "HDR" in the "Search HealthUnlocked" box in the upper right corner to see the many postings on this subject, or search Google for ( HDR brachytherapy side effects HealthUnlocked ), or whatever.

Best of luck with your procedure and your recovery. It was very effective for me. I hope it will be for you.


Arthro92 profile image
Arthro92 in reply to AlanMeyer

but, C, you had EBRT in addition to HDR. i'm taking 50mg. of casodex and will do HDR. do you think if you'd had HDR alone, you wouldn't have had as many symptoms or your symptoms wouldn't have been as severe?

AlanMeyer profile image
AlanMeyerModerator in reply to Arthro92

I am quite sure that some of my symptoms were EBRT related. The worst was aggravated hemorrhoids, lasting for some months. I don't think that the HDR could have caused that. As for the others, I know that the urinary difficulty was caused by my second HDR procedure. The first one didn't cause that and I was having no difficulty until immediately after the second procedure. However the urinary effects were not permanent and the procedure was successful. Long term, there were some sexual side effects and I suspect they may have been lower without the EBRT, which targeted the region around the prostate where I think some of the blood vessels that supply blood to the penis are. So, yes, I suspect that my symptoms would have been fewer and less severe without the EBRT.

I've needed no more treatment after that second HDR. I'm thankful for that and I would choose the same treatment again if I could be sure of the same outcome.

Best of luck.


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