It seems like a few members of this board are going through SBRT treatment at Memorial Sloan Kettering (MSK) right now. I just finished my five day course of SBRT treatment there today, and thought I'd share my experience as well in case it's helpful to anyone going through it or considering it.
My experience with MSK was overwhelmingly positive and I feel fortunate to have such easy access to it in New York. I had HDR brachytherapy a month ago, which went very smoothly, and the SBRT treatment over the past week. (No ADT in my case.0
The SBRT treatment itself has been easy. MSK handles a lot of patients every day so there can be a wait for your turn on the table, but the whole treatment itself lasts about 25 minutes. You check in, drink a cup of water (to make sure your bladder is full during the treatment) and wait to be called into the treatment room. They snap you in the mold, the VARIAN machine starts its rotations, and the process is painless and quick. The hardest part is waiting to pee once you're done!
You do have to self-administer an enema every day before you go in... frankly, I found that was the most unpleasant part of the whole process. I saw some people on this board asking whether you could go to work before or after treatment... I wouldn't advise it. End to end, the whole thing can take 3-4 hours every day, and there can be delays, so I took the week off from work. (If you're not going to take time off for cancer treatment, when would you take time off?)
In terms of side effects, on the whole they've been negligible. My urination has been fine (taking Flomax every night)... no burning or irritation. I felt a bit of leakage one day, but it went away. No other concerns.
In terms of rectal irritation, I had some mucous leakage on day 4, but that also went away. I'm taking Metamucil every morning and evening, and have had no other GI issues.
In terms of sexual function, between the brachytherapy and the SBRT, I am definitely noticing that my erections are not as hard as they were a few months ago, but I can still easily maintain an erection. I'm taking 5mg Cialis every night, and still able to have sex without any problem. My ejaculate is next to nothing at this point, but all things considered, I feel I'm doing ok.
The biggest side effect has been fatigue, which varies day to day. I'm making sure to get out for a long walk or two every day. I wish I could get back on a bike, but have been told to avoid that for another month. Getting out and moving around definitely helps keep the fatigue at bay.
At our follow up appointment today, the doctor said the odds were 90% that this was "cured." He expects my PSA to drop over the next year to below 1, and ideally closer to zero. He and the oncology nurse said the short term side effects should start to dissipate after two weeks.
I'm very encouraged by how all this has gone, and wishing luck to everyone else going through this. I would definitely recommend both HDR brachytherapy and SBRT as a course of treatment, and MSKCC has made the whole process as easy as anyone could hope for.
I also want to say this bulletin board has been a fantastic resource... thank you to everyone who has shared their experiences... I hope sharing mine might help others as they go through this.
Written by
MAL208
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Thank you. I saw Dr. Shasha for the first time last week and we discussed HDR brachy and SBRT. I will see him again next week. I'm really glad to hear about your results and your satisfaction with Shasha. I was impressed on my first visit.
Thank you so much for this. I'm glad it went so smoothly for you. I'm going to be doing it, the exact same treatment, at MSK. And yes, I wondered about work. I will just take off. Thanks for all the details on side effects. I really appreciate. Were you on the low-dose Cialis as a prophylaxis before treatment (and now during and after for a while)?
Good luck with your treatment. Dr. Shasha was my RO as well... he and his team were all great to work with! Yes, I started the low dose Cialis a week before the brachytherapy as a prophylaxis. I'm supposed to continue it for 6 months and then re-assess.
Thank you. I'm glad to find folks who were treated by Shasha and to know they were satisfied. Was hard to find on here for a bit. Thanks again. And good luck to you.
Your experience and the well explained post will definitely help many others who are planning to undergo HDR - Bracheytherapy + SBRT as their treatment protocol. I think you have a great chance of being cured of your medium risk PCa - GS 7. Good luck and my Best Wishes !
I had the ADT/ LDR brachy/SBRT from the MSK menu in July/August 2017. My trip started out at a GS9 and a PSA of 12.4. Most of my prostate was affected. Dr. Zelefsky at MSK did my brachy and I had my radiation done at their facility in Middletown NJ. My list of side effects, are mostly due to the ADT treatment I went through for 18 months. When I had the SBRT/Brachy done, I was one of the patients at the beginning of the protocol. It was a new treatment on the menu. I think Without the ADT, it would not have gone as good as it did because of the aggressiveness of my cancer. My current PSA is .05. It was <.05 for almost a year and has moved up a bit. The ADT has killed my testosterone and it will probably never come back to anywhere near pre cancer numbers. Even though I took viagra for the longest time trying to stave off impotence, nothing has worked. The ADT really did a job on me. You are lucky to have avoided Lupron. Believe me. Best of luck on your journey
I'm soon to start treatment although what treatment is yet tbd. I've had a biopsy resulting in a Gleason score of 7 with and CT & Bone scans showing no lymph node or bone metastases. I'll be meeting with my Urologist next week to discuss treatment. You mentioned both HDR brachytherpay and SBRT, are these two separate procedures done back to back? FYI - I live in CA so working with the healthcare systems in the community I live in.Appreciate any inputs you have ~ Marrix
I strongly recommend visiting, If you can, a center of excellence like UCSF or UCLA or City of Hope or USC and speak with radiation oncologist at least for their opinion.
I'm new here but to answer your question from what I've learned: Either can be a monotherapy, or they can be in combination -- just depends on your case. If done in combination, as in Mal208's case, HDR brachy is done first and SBRT is done one-month later (and includes several sessions, as he describes). My RO, who is his RO, is advising the same combination treatment. I'm G7 (3+4), localized and no ECE. MRI: PRADS 4. But even though that may sound similar to you, there may be reasons why combination is more prudent for me than it might be for you.
I just completed SBRT in July, 2021.No ADT. My Pre treatment PSA was 19.3. Recently i had my first post treatment PSA was 10 days ago and was 5.1. My RO just had his NP schedule a telehealth conf with me to discuss my case. My SBRT went very smoothly, no side effects etc and I feel fine. I am 81 with GS 3+4=7...no metastasis. Just wondering if i am being unreasonable demanding a meeting, in person or telehealth, with my RO instead of his NP? I have no idea what others typically experience, but I am sort of dumbfounded that my RO wouldnt meet with me himself at this first follow up meeting which is critical to me. Any advice, experience would be appreciated. I am looking for a new RO. Thanks.
Doesn’t seem unreasonable to ask for a telehealth meeting w your RO. On the other hand, you may be in better hands w a nurse practitioner for practical follow up. It will be some time, possibly years, before your PSA reaches its nadir. In the meantime, there may be side effects. The NP should be able to advise you on those issues. Best wishes to you!
Hi again! So pleased that everything worked out so well for you. The clear and detailed description of your experience will be a source of comfort/support for many. The best to you!
Great post! What condition prevented you from just having HDR Brachy or SBRT as a monotherapy? I just finished my third round of SBRT/MSK Precise yesterday. Right now, my course is just SBRT (I was diagnosed with G7 (3+4), 10%). Good luck to ya!
Thanks for your comments............ I am a long time patient of the great MSKcc and I'm there so frequently they're thinking of putting me on their payroll.....
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