HD Brachytherapy or SBRT

[PopCubby]

I am trying to decide between HD Brachytherapy and SBRT. I am Gleeson 7 4+3.

Both options seem to be equally effective. My doctor seems to favor HD Brachytherapy

[Tall_Allen]

That was my final two too.

[PopCubby in reply to Tall_Allen]

I just discovered this site yesterday, but I believe I've seen some of your posts and you seem quite knowledgeable, so I would appreciate your input.

I wanted to give you more background about my situation, but it seems like there is a limit to the number of characters I can post.

After originally being diagnosed as Gleeson 8 by my Urologist, both Hopkins and Fox Chase Cancer center in Philadelphia reread my slides and concluded I am Gleeson 7.

I prefer radiation over surgery, and as noted was offered HD Brachytherapy or SBRT at Fox Chase I like the idea that the SBRT is non invasive, but the radiologist at Fox Chase said he "has a bias" towards HD Brachytherapy. Fox Chase no longer does LD Brachytherapy.

I need to followup with him this week to clarify why he favors HD Brachytherapy.

Do you know of any benefits of HD Brachytherapy over SBRT?

Has anyone else had treatment at Fox Chase?

Are you happy with your decision?

Thanks

[Tall_Allen in reply to PopCubby]

Eric Horwitz at Fox Chase is certainly a great expert in HDR-BT. Radiobiologically, the two treatments are identical. There is no oncological reason to choose one over the other. In my case, I had the choice of two pioneers in their respective fields. It came down to the fact that SBRT required no hospital stays, no anesthesia, and was quite a bit less expensive. But I could have tossed a coin and been happy with either.

[ADuC in reply to Tall_Allen]

What is the cost of SBRT? I only have medicate a and b and need to figure out of pocket. Also is HDR-BT fully covered? Thanks

[Tall_Allen in reply to ADuC]

Everyplace charges differently. If the facility won't tell you, you can call CMS and see how much they reimburse. HDR-BT is covered.

[ADuC in reply to Tall_Allen]

Thanks

[PopCubby in reply to PopCubby]

Thanks for getting back. Dr. Horwitz is who we met with and who has the bias towards HDR-BT. I didn't realize he was so well known. That knowledge, along with the fact that Fox Chase's reading of my slides matched Johns Hopkins reading 100% gives me more confidence having treatment there. They both downgraded the same 2 slides from the original reading made by the pathologist my Urologist uses, which took me from Gleeson 8 to Gleeson 7. That was quite a relief, since as a Gleeson 8, surgery was the only realistic option in my mind since the radiation option included 2 years of ADT. Now radiation without ADT is an option, which in my mind is preferable to surgery.

Dr. Horwitz's bias towards HDR-BT then may be because that is his specialty.

I appreciate your input. It's great that you take time to share your knowledge to help guys like me who are trying to figure the best treatment.

Thanks again!

[Bigm789]

Did u experience any side effects , burning urination, frequency, painful or reduced ejaculate volume of semen?

[carlsbadjack]

Following

[teacherdude70]

All I can say is that with my Gleason 9 I had both with the HDR Brachy Boost twice.As you have read often, We are all different, so to that end they were no big issue.

[westof]

Hmm... My dx ( 3 years ago) was also G9, but luckily S3.

Had HDR Brachy (4/2019) and IMRT (25 days) 3 months after, at MSK.

Also, was on ADT for 2 1/2 years (tapered off Z & P in January) and stopped Lupron 7/2020.

Had bone and CT scans last month and no evidence of any mets.

The scans indicated that I'm basically "unremarkable".

Hmm..." Darling wife of 48 years agrees!"😕

Best

[NotDFL]

The radiation parameters for SBRT were based on those for brachy, at least initially when SBRT was in its infancy. Both methods require a specialist (and for SBRT, a specialist team), so I strongly recommend that you decide on that basis. I don't agree with the above statement that SBRT is non-invasive. The placement of the fiducials is invasive, and, in my case, was done under anesthesia. The actual SBRT sessions do not require anesthesia, but you already knew that.

I will repeat; go with the best (most experienced) specialist.

[PopCubby in reply to NotDFL]

Thanks for the input. Do you know if Brachytherapy requires fiducials?

[Tall_Allen in reply to PopCubby]

Yes, they place fiducials for HDR-BT while under anesthesia. They are necessary for treatment planning. SBRT fiducial placement should be transperineal and requires only local lidocaine for the 3 fiducials. It is injecting the gold seed in and not taking anything out as in a biopsy - it takes under 5 minutes.

[NotDFL]

No fiducials for HD brachy AFAIK; the RO will place carefully calculated amounts of radioactive material in your prostate based on a map of your prostate (from the scans). After the correct dose has been delivered, the radioactive material will be withdrawn.mskcc.org/cancer-care/patie...

[timotur]

Two years ago, I had HDR-BT/IMRT/ADT-18 months for t3bN1+SV. Ended ADT a year ago, now PSA: 0.02, T: 700. Highly recommend Brachy, especially for advanced or high risk PCa. (see profile)

[Christo1]

Greetings from a first-time poster, long-time lurker. I had Gleason 3+4 from 6 of 12 cores and 3+3 in the rest. Being a geek I did a huge amount of research and evaluated all my options based on three criteria in decreasing importance: 1. Efficacy, 2. Side effects, and 3. Invasiveness. My takeaway was that all three had the nearly the same efficacy. Side effects were also similar, with surgery (RP) being the biggest wild card - if done correctly side effects are low but that requires using (literally) one of the top 3-5 surgeons in the country. HDR Brachy and SBRT were more or less tied. Lastly, for invasiveness the clear loser was surgery and, while HDR Brachy was not too bad (2 days in the hospital and an overnight stay between), the nod went to SBRT. My ultimate choice.

I interviewed a number of ROs and ultimately went with Dr. Bob Meier at Swedish Hospital in Seattle after he was given a recommendation by Alex Gottschalk of UCSF. I'm now 2+ weeks post treatment. Like others have said, the feeling after treatment was one of wondering if the machine was actually turned on as you felt nothing. I will add that the first 10 days post did include some tiredness, a bit of burning during urination or orgasm (which I am pleased to report works as well after as before), and very loose stools. Virtually all of those symptoms have abated at 2 1/2 week post. [BTW, Swedish uses 4 gold marker/fiducials and Tall_Allen must be tougher than me because I also had them placed with just a local anesthetic and I nearly jumped off the table with each one!]

Sidebar to Tall_Allen: Thank you for the selfless sharing of so much information! I too, have benefited it from it. I was very late in finding this support group and with my other research had also come to decide it was between HDR BT and SBRT and your detailed explanations tipped the balance for me. Thanks again, I intend to pay it forward.