Travel after HDR brachytherapy?

[Smallfall]

I'm scheduled for 1-day HDR brachytherapy at UCSF, with Dr. Hsu. Can anyone tell me what to expect immediately after the procedure; will I feel like/be able to travel that day?

[Tall_Allen]

You are likely to be sore. If you are taking a long drive, sitting may be painful and bring a bottle to pee in.

[Smallfall in reply to Tall_Allen]

Thanks, I'll probably stay in SF another day (especially since I won't be able to eat much the day before).

[curtisbirch in reply to Tall_Allen]

Since you didn’t have this procedure, you should probably leave this answer to those that have.

[Tall_Allen in reply to curtisbirch]

I've been with several patients who had it and know several ROs give it. They have referred patients to me to talk to them about it. Do you have a different experience?

[curtisbirch in reply to Tall_Allen]

Tall_Allen, I'm thankful for your help on more than a few of my concerns over the years -- I know many others here are as well. But when it comes to talking about what it feels like to have a certain treatment, I think you need to make sure people know that you're not offering firsthand experience in cases like these. I, for example, didn't have soreness after treatment and that could be a big revelation for those considering treatment options, like LDR seeds, HDR brachy or SBRT, for example. Or, someone might be faced with an important meeting that they'd like to try to attend after their brachy treatment --I don't think that's out of the question, based on my experience.

I believe there's a misconception that HDR brachy is far more invasive than it actually is. Before I had my treatment with Dr. Wong (a student of Dr, Dimanes), I had concerns about the insertion of catheters, and the extreme discomfort that it might cause me. I was expecting something more akin to a surgical procedure. In reality, it was far from it. The catheters are very fine and far less intrusive than one would expect. I had absolutely no pain and no bleeding. In sum I was totally blown away by how basic the whole thing was. I remember my first thought was being incredibly grateful I hadn't gone through with RP.

Maybe it helped that my expectations were that treatment would be more challenging. Before I had my procedure, I read here that someone played golf right after treatment. There was just no way I could believe it because I'd never heard someone say that it was a breeze. There were only these textbook "what to expect" type answers about soreness, bleeding and burning.

The procedure for me was honestly far less of an ordeal than getting my biopsy. I'm not at all saying we shouldn't hear from people weighing in with good studies and guidance gathered from doctors. But we'd also benefit by hearing more from those willing to share their own treatment experiences.

HDR brachy is a highly effective treatment for intermediate risk prostate cancer and for that reason, I believe more people should know how easy it can be. That way there might be less of a barrier when people are considering it.

Getting back to the original question. I could have traveled the same day as my treatment. But I'm glad that I had a hotel room so I could let the haze from the anesthesia fade off and not feel pressure to move through an airport and get on a plane if I wasn't in the mood for it. It was nice not having to travel after treatment. But I did end up going out to dinner that same night.

Best of luck at the treatment Smallfall. Please let us know how it goes. And thanks to everyone here for always providing good healthy dialogue and vital back and forth. The doctors never have all the answers so what we share here becomes so important as we help each other fill in the blanks.

[Tall_Allen in reply to curtisbirch]

Your experience may be different from average. I spoke to several guys and their ROs who had exactly what I described. Why do you believe that your experience is worth listening to and theirs is not?

[curtisbirch in reply to Tall_Allen]

I definitely think you should be sharing that info. I just believe that you should let people know that you are sharing information you collected rather than presenting it as firsthand information. It'd be as simple as mentioning how you got this information when you share it. Reading through this thread, it seems that I'm not the only one who had no soreness with sitting post treatment. If I wrote something here about what to expect after SBRT treatment, I believe that you, being someone who actually went through this treatment, would want to me to qualify my POV the same way.

[Tall_Allen in reply to curtisbirch]

When your doctor tells you what to expect, do you imagine that he himself has experienced it? Do you think I'm lying about what patients and doctors have told me? Why would I do that? My treatment is in my profile for anyone to see.

[timotur in reply to curtisbirch]

Well said Curtis about Brachy, when I first learned about it, it seemed draconian, but the more I learned, it seemed like the best option for advanced t3b. It's an invasive procedure, but remarkably pain free after it's over.

[Smallfall in reply to curtisbirch]

I don't know what Tall Allen has done or been through, but I do know he has given me a lot of very good info and advice, more so than many professionals...

[aceace12 in reply to Smallfall]

i agree if i could i would schedule an appt with him ... LOL

[Classical6 in reply to curtisbirch]

TA is correct and I had the procedure.

[timotur]

I had HDR-BT last year with Dr Chang/UCLA, and had no problem after the procedure. I elected not to travel the same day, and rest, but travel back to San Diego would have been possible with my wife driving. I wouldn't have driven myself as I was too tired from not sleeping much the night before, and the after effects of being on Propofol .

After the procedure, I walked back to the hotel, took a three-hour nap, then, the moment of truth, took my first pee, and there was some burning sensation, probably from the cystoscopy or catheter during the procedure, but not too bad. Later the evening, I was able to walk out to get some dinner near the hotel. There was some peritoneal soreness, but not anywhere near what I expected. I didn't have to take any of the three meds I was given for pain, urine flow, or infection. The next morning, I was able to drive two hours home with no problems. I had SpaceOar, and it was noticeable, but not obtrusive.

If you're traveling by car and have a driver, should be no problem if you can take breaks as needed, just expect that first pee or two to burn. If you're flying, you may want to get a late flight, and see how you feel before getting on the plane, and if needed, just check into a hotel and go the next day. One thing, take a few Depend diapers to wear as there is some slight oozing around the peritoneum for the first day or two. I didn't have any IC or other SE's.

[Smallfall in reply to timotur]

Thank you for this detailed and helpful response.

[BRCA2MX]

From an actual Hsu one-day, one-dose brachy veteran (2015): Travel should be OK if slightly uncomfortable (perineal area tender for a few days.) If you have good urine flow/control (almost always) irritation is minor. Lotsa neat purple bruising possible but no correlation with pain -- and who's looking??

I was unnecessarily trigger happy on the morphine (in patient hand) control as reviews warned me of Demanes/UCLA moving catheters mid-procedure with re-MRI/CT look. Turns out UCSF does NOT reposition catheters in one-day, one-dose ('1 and done') procedure. So no worries.

Hsu was a student of Demanes way back but today has passed up the teacher, especially with the one-&-done procedure. He has a great success rate and data history he'll share if asked. UCLA was hesitant with 1&done so I went with Hsu.

For high grade guys, UCSF is comfortable with one-&-done & it WORKS! [--excellent low BCR data.] Even if you don't fit the exact criteria for one dose/fraction only, I know guys that have had Hsu's 2 fractions in one long day visit and it too works well. These are not highly promoted procedures because Medicare reimbursement is not great for RO's (weak Beltway lobby?) but it has terrific (good) outcome performance if you can find a good RO that does it--and has many in their history. I believe you can't do better than Hsu and UCSF team.

You've made a good call with a great practitioner. Super MD who loves tough questions--I respect that.

**I found a medical-supply store sit-upon foam rubber/urethane 'donut'<< thats what the stores call it! --(left over from my saturation transperineal biopsy) REALLY helped with sitting after HDR too. Great while driving and just sitting at home tho not vital--just nice on a tender area... I'd call it a 'range extender.' ;o)

***I had zero ooze or leakage, YMMV.

****I'm 5+ years out and still undetectable PSA (<0.01 vs GS 4+4, 16 PSA @ Dx,) did IMPT for pelvic radiation adjunct. (+16 months of ADT.) Feeling blessed.

[Smallfall in reply to BRCA2MX]

Wow, that is all great to hear; congratulations!!

[timotur in reply to BRCA2MX]

Nice result BRAC... wonder how long to nadir, then how long to spike? Mine was only about 5 months to n/d, and has stayed there for the last year.

[BRCA2MX in reply to timotur]

No real spike. Nadir did take ~5 months (undetectable.--then <0.015) Had a 'micro bounce' to 0.016 and 0.017 then back down to <0.015 [and <0.01 with different assay] over a 3 month period 2 years later. Got my attention big time, but multiple MO's say 'that's hardly a bounce' and a bounce is good anyway.

ADT was hell for me (bailed at 16 months.) But still NED 5+ years later (PSA & imaging) for a BRCA guy I feel very, very blessed.

[timotur in reply to BRCA2MX]

Thanks, that's very helpful to know what to expect hopefully coming off ADT. Interesting that you had a mini-bounce at your very low levels, and that our time-to-nadir was the same. Five years n/d is indeed a blessing-- congrats, hope for another five and more. Agree on ADT, the last few months were tough, I had to talk myself into the last couple of monthly shots. - cheers, Tim

[curtisbirch in reply to BRCA2MX]

It'd be great to see your PSA history post treatment if you don't mind sharing -- curious if you had a lot of bounces like the rest of us. Those bounces, I have learned, are to be embraced. Thanks for posting!

[BRCA2MX in reply to curtisbirch]

See my reply above. Dx PSA 16, GS 8 (4+4). One total (tiny) bounce (so far...)

[tsim]

I probably should chime in here since I had two HDR Brachy sessions a couple of years ago. First of all, when you look down it's going to look like a giant acorn sitting on top of two Italian plums. Don't freak out, this will be gone in a week or two. There really wasn't that much soreness or discomfort but I would still recommend not traveling for a couple of days after. The main reason is for possible urinary or other issues. They won't discharge you unless you can produce maybe 100-200cc of urine easily. I could, but that didn't last very long. I left the hospital around five and by eleven that night I was down to droplets and by four I was completely stopped up. Necessitated an early morning trip to the ER to have a catheter placed. (My second session I just told them to leave the cath in for a couple of days) Make sure you have the nappies and bottle on hand for a while. (Are you getting external beam rad as well?) Good luck and a speedy recovery.

[Smallfall in reply to tsim]

Thanks for your info. Yes, I'll start external beam as soon as I can.

[Xcrunner1988]

i received my initial HDR Brachy there in 2015. Salvage HDR Brachy at UCLA in August. Both with Dr Chang.

Really pretty sore and quite painful urination the first 48 hours. Could I have gotten on a plane? Maybe with pads. But really glad I didn’t.

I flew home 3 days after last dose with no problems.

In three months PSA dropped from 6.8 to 0.4. Treatment seems to be doing its work.

All the best to you.