HDR in Calgary

[soabguy]

Has anyone out there had HDR BBT at Tom Baker Cancer Center in Calgary, Alberta? I am scheduled for the procedure soon and am wondering if anyone could provide me with their treatment success at this institute?

[AlanMeyer Moderator]

I have no experience with the Tom Baker Cancer Center in Calgary, but when I looked them up I was surprised and impressed by the very large number of radiation oncologists on the staff there. It looks pretty obvious that they specialize in that kind of treatment and are deeply experienced in it. That's a very good sign.

I was, myself, treated with HDR brachytherapy + external beam + Lupron at age 57 in 2003-2004 in a clinical trial at the National Cancer Institute. The treatment was for a PSA 10.7, Gleason 4+3, with tumor extensions through the prostate wall into surrounding tissue. I had one session of HDR, followed by 25 sessions over five weeks of "3D-CRT" (three-dimensional conformal radiotherapy) external beam, followed by one more session of HDR. The treatment straddled the Christmas/New Year holidays and so the scheduling was disrupted somewhat but the total treatment was 2 HDR sessions + 25 EBRT sessions.

There were side effects. I had inflamed hemorrhoids, I needed tamsulosin (Flomax) in order to be able to urinate, and it took me five months before I could get off it. At its worst, for about six weeks, I woke up about once per hour to pee into a bottle and then go back to sleep. I had some scarring in the rectum, and I had gradually increasing impotence that, by about five years later made penetrative sex impossible - though not other kinds of sex!

I think HDR was still in early use at that time and may be improved now. I know that the 3D-CRT radiation I received is not as sophisticated as it is now.

Now, 17 years later, I've still needed no other treatment. I'm happy with the outcome and I call it a success.

Hope that's useful info for you.

Best of luck.

Alan

[miscdenver in reply to AlanMeyer]

Hi Alan:

Thank You for sharing your experience.

Congrats on your treatment's success.

My situation is quite identical to yours. Started with a suspected UTI visit to the doctor. Urine came out clear. Blood test showed a PSA of 25. PSA had never been tested before.

Biopsy: Gs 3+4, 80% on left, 1% on right, graded T2c. Bone & CT scans were clear. MRI showed T2 score 5 = PI-RADS Category 5

Options were RP with 2 years of ADT (Lupron), OR, Short ADT (1yr-two 6-month Lupron) + 20 sessions of EBRT + 1 HDR Brachy (needles)

Going with the latter treatment plan. I'm 68.

Started with Casodex, will be getting the first Lupron in a few days. Apprehensive about its after affects. I'm in Denver, in care of a very competent RO and team.

Did you get Lupron? How was your experience with it? Should I ask for the 3-month inj instead?

Any suggestions you can offer from your experience, pls?

Thanks & best wishes for your continued success over PCa.

AK

[AlanMeyer Moderator in reply to miscdenver]

Like you, I was scheduled to receive two years of Lupron, starting out with the standard Casodex dose to hold down effects of the testosterone flare caused by Lupron. This was actually at a time when the NCI group wasn't using Lupron but information was just coming out that there were significant differences in outcomes, especially for men with Gleason 7, in favor of neoadjuvant Lupron, so the trial was changed and I was possibly the first guy in the trial to get Lupron (it was a trial of MRI guided HDR seed placement.) The NCI radiation oncologist gave me a 30 day dose rather than 3 months or longer just on the off chance that I had a bad reaction to the Lupron.

When the 30 days were up, I came back in, was given a set of blood tests, and a 3 months shot. Then the results of the blood test came in and it turned out that my liver enzymes were elevated to dangerous levels. It was too late to do anything about it because I had already had the next 3 months shot, so I had to continue on Lupron, but no more shots were given when the 3 months were up. The final result was that I had about 2 months worth of Lupron before radiation treatment started, another month's worth during treatment, and (theoretically) another month's worth after the end of radiation. In practice, my testosterone actually only started reviving after 5 months and didn't become noticeable to me (by the end of hot flushes and the beginning of the revival of libido), until about 5-1/2 months after the first shot.

I think there is something to be said for getting a shorter duration course of Lupron before committing to a longer one. I don't know how many men get dangerous adverse effects and don't even know how dangerous mine were, but the docs were cautious about it.

One thing that I recall from my research on Lupron is that, although the benefits are dose/duration dependent, the benefits are not evenly spread. Most of the benefits come from the first 6 months of Lupron. Some more occur before the end of the first year, and some more before the end of the second, and even a tiny bit before the end of the 3rd year. But there are diminishing returns. My totally inexpert opinion is that your choice of the one year protocol is a good one. The only downside of taking 3 months shots instead of 6 is that you have to get one or two more unpleasant injections. That doesn't seem so important to me. So I don't think it's a bad idea to start with a 3 month shot but, if possible, you do want to at least carry the Lupron through the entire period of radiation plus at least some time after so that the Lupron and the radiation can work together. Also, be sure to get a full battery of tests (testosterone, PSA, liver enzymes, and I don't know what else) early enough before the second shot so that there will be time to see and discuss any adverse effects before committing to the next shot.

Good luck with it all.

Alan

[AlanMeyer Moderator in reply to AlanMeyer]

I will add more info about Lupron effects. I had the usual hot flushes, about an hour apart. I would wake up at night in a sweat. Each flush lasted about a minute or two. The other effects included a total elimination of sex drive (I couldn't imagine that before it happened, but it did happen) and a reduction in athletic ability - both strength and endurance. I treated the effects as follows:

Hot flushes: Not a big problem for me because it was winter when I had them. If it were summer, I would have kept a fan nearby and used it when needed.

Loss of libido: I forced myself to have sex even though I had no desire for it. I would make love to my wife until she became aroused and, to my surprise, her arousal would arouse me and the whole process could be enjoyably completed.

Loss of physical strength: Exercise, every day if possible. It didn't restore my strength to its baseline, but it kept me from becoming a couch potato.

In conclusion I'd say that Lupron is pretty unpleasant. I didn't like it at all. But the literature I read back in 2003 indicated that the scientists were seeing a 33% increase in the cure rate (from 62% cure to 83% cure) for Gleason 7 patients undergoing radiation. I was very willing to put up with some unpleasantness to get that. I don't know if those numbers are the ones still used today but I think Lupron is still considered worthwhile in radiation treatment for men with our diagnosis.

Alan

[miscdenver in reply to AlanMeyer]

Thank You Alan.

Your detailed thoughts and your experiences with the side affects are much appreciated.

I've sent a msg to my RO about monitoring liver enzymes but I may be too close to the 1st Lupron appt to get a response.

Take Care and Stay Safe !

[miscdenver in reply to miscdenver]

Actually, just received a response from the RO:

"Long term Casodex is more commonly associated with elevated liver enzymes although the chance is still low (6%). Lupron has an even lower chance of causing significant elevation of liver enzymes (<1%) so it has not been my practice to check liver function tests because it is so unusual. Nonetheless, I have placed an order for LFT's should you want to have your liver function checked."

[AlanMeyer Moderator in reply to miscdenver]

Out of curiosity, please let us know what the test results are. My inexpert guess is that it might show some elevation but, as the RO suggested, not significantly so.

[miscdenver in reply to AlanMeyer]

AlanMeyer Hope all is well !

I haven't done the LFT yet but have other developments to share.

A recap of my situation is that I'm about a month away from starting my 20-session radiation therapy, after that will be the HDRB.

I had the 6-month Lupron intake about 5 weeks ago. Had pressed for and gotten a PSA test when I began Casodex, a week earlier. At that point it was 17.9 (Down from 25 when was first discovered on 12/29/20)

I was desirous of getting PSA tested about every 30-45 days after that but that was turned down by my HMO, with the reason: 'unnecessary'. They have the next scheduled for August, after all the remaining treatments.

I was having PSA anxiety, so decided to go out of pocket and got another test done last week by an independent lab, at D+30 since Lupron. It came back as 1.7

So, checking if you'd have some thoughts on this magnitude of drop, from your experiences on this forum?

Looks a pretty good drop to me. I've made some major diet changes as well and wondering if that has augmented Lupron's impact.

Also, to mention briefly, that (KOW) I've not had any noticeable of the most dreaded side affects of Lupron so far.

Thanks & Regards

KM

[AlanMeyer Moderator in reply to miscdenver]

Hi KM,

I don't know how long it takes to get the full effect on PSA from Lupron, but I do know it takes a while and your move from 17.9 to 1.7 sounds good to me. I expect it will go down significantly more by the time of your next test.

I'm surprised you haven't felt many negative effects of the Lupron yet, but perhaps I'm thinking of different "dreaded" effects. I think my complete loss of libido might have taken four weeks or more to occur, so you may find that soon. I expect the hot flushes and energy/strength drains will come soon too. It's a good idea to get in the habit of exercise to be prepared. I also suggest getting a testosterone test, perhaps at your next PSA, especially if you're not feeling negative effects. We know that the Lupron is working because your PSA has come down. However I know of cases where it wasn't working as well as expected and the T level was higher than the patient needed. I knew one guy whose T level only went down to 87 on Lupron, which is definitely above "castrate" level. He was a very big guy, 6'5" and over 300 pounds. Maybe that was a factor. Seeing that his T level was higher than expected, his doctor put him on continuous Casodex as well as Lupron and his PSA can down.

It sounds like things are going very well.

Good luck with the rest of your treatment.

Alan