Recently diagnosed, Seeds vs HDR Brachytherapy?

[Pop_Meme]

I'm new here and I'm here for my 65 year old husband. He's Gleason 7, PSA 33, biopsy results was 3 out of 12 cores positive, 2 were 7(3+4), one (4+3) with 90% of core involved. He has researched enough to know about seed implants and likes the idea in theory..... in my ignorance I thought brachytherapy always referred to "seeds". Can someone tell me if either of these options would be a good treatment choice for him?

[Tall_Allen]

Seeds (low dose rate (LDR) brachytherapy) is not a good treatment option as a monotherapy for GS 4+3. It would have to be combined with external beam radiation to be curative. The combination also increases side effects.

HDR-BT can be given as a monotherapy and has very high cure rates and low side effects. There are not a lot of specialists - where are you located?

SBRT is also a good option as a monotherapy.

[Pop_Meme in reply to Tall_Allen]

We are in the Birmingham, AL area. We meet with a surgeon and separately with a radiation oncologist on Monday. What about surgery? Does HDR brachytherapy have about the same results (other than more side effects/recovery time)? What about reoccurrence with brachytherapy vs surgery?

[Tall_Allen in reply to Pop_Meme]

Read this:prostatecancer.news/2018/10...

Surgery has equivalent oncological results for favorable risk PCa, but radiation has better results for unfavorable risk PCa. (GS 4+3 is unfavorable intermediate risk).

Does UAB offer HDR-BT?

[Pop_Meme in reply to Tall_Allen]

I just did a search and UAB does offer HDR-BT, so we will look into setting up a consultation there. We are currently talking with Urology Center of Alabama but they appear to only offer the permanent seeds. We have 10 grandchildren and on their website it mentions not having close contact with children for several months when you have the seeds.... that would not work.

[Pop_Meme in reply to Tall_Allen]

Can you tell me more about SBRT?

[Tall_Allen in reply to Pop_Meme]

5 external beam treatments. Radiobiologically similar to HDR-BT (in fact, it was modeled after it). No anesthesia, no hospital stays. I had the choice of either from the world experts in each. Both are excellent. I chose SBRT because of how easy it was and a lot cheaper. Idk if you can get it in Birmingham. I know it's available in Atlanta.

[Pop_Meme in reply to Tall_Allen]

from my research, it doesn't seem to be available here.... but as I said HDR-BT is available at UAB, so we will be talking to someone there. Thank you for your help but I do have one more concern with taking the "radiation" course of treatment. My husband's urologist said the cancer was only on the left side of the prostate... in 3 of the 6 cores.... but there was one core on the right mid that was described on pathology as atypical small acinar proliferation, suspicious for carcinoma. If only the left side is targeted.... should this be a concern?

[Tall_Allen in reply to Pop_Meme]

90% of unilateral PCa on biopsy is bilateral at prostatectomy. They always treat the whole gland plus a margin around it.

[Pop_Meme in reply to Tall_Allen]

that's good to know.... I was thinking the radiation was targeted at tumor only

[1Ubspaine]

I am 64 and had a very similar diagnosis to your husband. After firing my over anxious Urologist in suburbs of Dallas, I went to UT Southwestern(a teaching hospital in Dallas) and received excellent mostly unbiased advice from their physicians.I chose the 5 Radiation treatments and also received a short time treatment of Androgen therapy.

I am very pleased with the results and advice.

By the way, most for profit places suggest 40 radiation treatments, I asked my R.O. why she suggested 5 and her reply was in most cases 40 are much more profitable than 5, that is the business of cancer treatment.

[conbio]

Hi there -

I was similarly diagnosed this summer -65 yo, very active- climb, ski, bike. I chose to go with the three legged stool of ADT, beam radiation, and the seed implants. I would encourage you to look at the two books of Mark Scholtz. (Invasion of the Prostate Snatchers and The Key to Prostate Cancer, 30 experts explain the 15 stages of prostate cancer.

Also, his Prostate Cancer Research Institute website has tons of good information. You can call them and they will call back and knowledgable folks will return a call and answer questions, for free. Here is an applicable example of some of his videos: youtube.com/watch?v=G06FmU5...(Not working as expected?)

I researched this to death (I'm a scientist) and and satisfied with my decision. Started ADT a month ago and will be on it for 18 months, beam radiation in Feb, a month rest, then seed implants. A very strong Canadian study showed this was the best results - starting ADT first See the ASCENDE-RT studies. isoray.com/2018/03/ascende-...

Lastly - don't freak out. Prostate cancer at this stage is slow growing and very treatable - chin up, you can both do this.

[Pop_Meme in reply to conbio]

Thanks, have already watched several of his videos in my own research.

[ADTMan]

My profile is similar to your husband. With a PSA of 33 he should have had a multiparametric MRI and a targeted biopsy instead of a random 12 core biopsy. That would tell him if he has extra capsular extension or extension into the seminal vesicles. You should also get a second opinion on the biopsy. There are nomograms which determine the probability of spread outside the prostate. I believe the probability in your husband's case is high. In my case I had HDR brachytherapy, 25 IMRT treatments and am currently on ADT for 2 years. Good luck.

[Pop_Meme in reply to ADTMan]

the blind biopsy of 12 cores does concern me, which leads me to lean toward surgery just so we have the post surgery pathology and know what we are dealing with. If we get a second opinion..... would they just look at the current pathology report or do another biopsy?

[ADTMan in reply to Pop_Meme]

If you get a second opinion, they will request the actual biopsy slides and evaluate them without looking at the first report. There can be a difference of opinion on the Gleason score. Like you, the urologist I consulted wanted to do a standard 12 core random biopsy without an MRI. I insisted and had a targeted 23 core biopsy. In my case since there was a high probability that the cancer was not confined to the prostate because my PSA was high and Gleason score. The bone scan and pelvic CT scan did not show anything, I knew I had to have radiation. Because PSMA PET has been approved, I would get one, even if I had to pay for it, although if you are going to have to have radiation anyway, it would not change the treatment you receive. IMRT with a brachytherapy boost should be recommended according the NCCN guidelines.

[TylexGP in reply to ADTMan]

Hey ADTman,

That is the same treatment plan I am following. I’m done with the HDR and 25 EBRT. Now just watching as I continue my ADT that includes Zytiga. I have G9 With SVI and one suspect node.

[ADTMan in reply to TylexGP]

How long will you be on ADT and Zytiga? I am on ADT for 2 years but no Zytiga.

[TylexGP in reply to ADTMan]

I will be on the ADT and Zytiga for at least two years.

[ADTMan in reply to TylexGP]

The ADT isn't as bad as I thought. I thought they would also put me on Zytiga but I was Gleason 8. I hope you post in the future so I can keep up. Thanks.

[WaterRat14 in reply to TylexGP]

Hello TylexGP. I just came across your reply to ADTMan you wrote 7 months ago. Your treatment plan looks like what I’ll be starting on. I’ve been on ADT since April 1. Getting HDR BT this Tuesday. Expect to start EBRT 2 weeks after. Told by RO that Zytiga for two years is likely warranted. He will refer me to MO for that. Being treated by Dr. Wong at UCSF. Can you share some thoughts on your journey, particularly about Zytiga?

[TylexGP in reply to WaterRat14]

Hi Waterrat,Glad to share I started Lupron and Zytiga a year ago May 2021. Followed by HDR Brachytherapy in July 26, 2022. A month later I had 24 sessions of EBRT in September 2022. The HDR and EBRT were a walk-in the park little discomfort and a little diarrhea. The ADT and Zytiga physically and labs has been well tolerated. I do have hot flashes and ED. The psychologic effect had been harder especially at month 5. Very emotional things from the past I thought I dealt with re-emerged and bothered me. Some depression but not severe. Imaging the future for my family without me. For me a supportive spouse with good communication and a good Psychiatrist specializing in PCA patients combined with excercise has helped me immensely. Most days are good days. Some others tolerable. Treatment wise PSA has at this point nadir at .11. Last scans in Feb 2022 did not detect any PCA and suspect pelvic LN no longer detectable. Would like PSA lower but happy if it’s stays stable. I have another year left of ADT and Zytiga as long as everything stays stable. I have had a good year all things considered. I am happy with my treatment decision. Happy to answer any additional questions.

[WaterRat14 in reply to TylexGP]

Thank you TylexGP. Your experience is consistent with what I’ve heard and read. Already suffering with mild anxiety possibly from Goserelin that I’ve been on since 3/28, but could be in anticipation of HDR tomorrow. Good to know yours was a “walk”. My wife has been wonderful. Just want to hold up my end. My daughter encourages professional mental support. Sounds like it can be helpful in this journey.

[TylexGP in reply to WaterRat14]

I hope all goes as uneventfully as my HDR brachytherapy did last year. Best of luck.

[WaterRat14 in reply to TylexGP]

Thx

[CAMPSOUPS in reply to TylexGP]

That's the second time I heard "Psychiatrist specializing in PC patients".I'd give my right arm for that lol.

The first time I heard it was probably from you.

I think it is a rarity to say the least to find one.

[TylexGP in reply to CAMPSOUPS]

Dr. Roth at MSKCC. He is awesome!

[fldrifters1]

Hello it's been 5 years in December since I had the 44 rounds of targeted radiation, tomo therapy. And before I started the radiation I had 6 months of lupron hormone shot. My prostate was 70% cancerous and I was a seven also. I have now regained just about my previous quality of life before treatment and even though it was the longer 44 rounds of treatment I would highly recommend it! Just keeping my fingers crossed things stay as they are, good luck to you and your husband it's going to be a stressful time for both of you but it sounds like you've got this thing early. Good luck to you both ,peace

[Pop_Meme in reply to fldrifters1]

Thanks, and glad to hear you are doing much better. We have the first of our dr appointments today.... one with a radiation oncologist, one with a surgeon.... on November 4th, we go for a second opinion at the cancer center here in our area. Hopefully, after these consultations, we can make an informed decision and get this journey started.

[Pop_Meme]

We have not yet been able to discuss the option of HDR-BT... we do that at UAB next week. However we did meet with a surgeon and with a radiation oncologist yesterday. We have been calling my husband's cancer, "Intermediate Unfavorable" risk. Both doctors yesterday referred to it as "high risk" due to his high PSA and the fact that the tumor was enhanced on the CT scan and the 4+3 core was 90% involved.... mostly though because his PSA is greater than 20. The recommendations were either surgery (possible radiation depending on pathology) or external beam radiation plus 2 years of ADT. I'm curious to find out if whether next week they will say it's okay to treat with HRD-BT only.

[Golferjfm]

I am 71 and I was diagnosed with the same symptoms about ten months ago. My Gleason was the same but my PSA was not as high as your husband's. I did a lot of research and spoke to several doctors regarding both surgery and radiation therapy. I ultimately decided on the radiation and my doctors said I was a good candidate for Sterotactic Beam Radiation Therapy, SBRT. This is a concentrated high doze beam but it is only five radiation treatments as opposed to traditional radiation which sometimes can be 20 to 40 treatments. My doctors said I was not a good candidate for brachytherapy (seeds) due to the size of my prostate.SBRT does require two pre-treatments prior to radiation for fiduciary markers and a spacer gel that protects the rectum during radiation. However, both of those procedures were straight forward. After that it was five treatments, occuring every other day. I did not have any bad side effects during the radiation and post radiation, I am feeling fine, without any negative effects. I would ask about SBRT. Good Luck.