hdr bt or sbrt

[Gmac6911]

just been diagnosed with Gleason 3-4 with 10 out of 18 positive cores. Psa is 3.9. Trying to decide between sbrt or hdr bt . Can anyone explain their side effects as I am concerned about urinary and erection problems . I was considering Hifu but it seems not as effective

[Tall_Allen]

It came down to the same 2 for me. They are pretty much identical in effectiveness and side effects. I could have flipped a coin. I finally decided on SBRT because it was easier and cheaper.

[timotur]

I had HDR-BT/IMRT with ADT four years ago with Dr Chang at UCLA with good results and no SE's. I chose BT because I had advanced stage t3b with one lymph node and seminal vesicle involvement (see profile). It seems you caught yours early, so SBRT may be just as effective.

[Wifey21]

My husband had LD brachytherapy in January for similar diagnostic presentation. He was clear that his decision was between SBRT & LDBT having been given a full range of options. He opted for LDBT as it was a shorter treatment with one day patient attendance for the procedure (& attendance next day to remove the catheter). He's very pleased with the choice, having minimal side effects. He had his 3 month review a week ago. He is now generally getting up once in the night, sometimes twice but this is reducing. He has some frequency/urgency occasionally & occasional slowness, but it's not affecting his lifestyle generally. His PSA has reduced from 6.6 to 4.1 in the 3 months.Hope this helps.

[CarverD]

I had HDR-BT 2.5 years ago as a mono-therapy for 7(3+4). Side effects from the procedure (sore perineum, etc) were all cleared up in ~3 months. I have slight urgency if I wait too long to urinate. No ED or erection problems, no incontinence. Two treatments a week apart; overnight catheter which I pulled at home in the shower. I am very happy with the outcome and would choose this path again. Feel free to contact me if you want/need more information.

[BB_1]

I completed my first week of proton radiation. 3 more weeks to go. No side effects yet.

[WilsonPickett]

I had SBRT (MSK precise) about 18 months ago at Sloan-Kettering New York City. I presented with the same numbers as you. Five treatments no hormones, now checking PSA every six months. Last reading in January was down to 1.35. No erectile dysfunction that isn’t fully age-appropriate. (I’m 67) no real discomfort to speak of. If I had to make the same decision again now, I would do exactly the same thing. Best of luck to you.

[crony]

One thing to get clear up front, the doctors that remove prostates have rent to pay. To them everything is a nail and they are the hammer. Please watch this video and if possible go to this doctor, good luck. youtube.com/watch?v=_AiZvd2...(Not working as expected?)

[dentaltwin in reply to crony]

Yeah, pretty sure radiation oncologists have rent too, as do I. The video link doesn't work for me. I hope you're not implying that surgeons are corrupt and radiation oncologists are not. Full disclosure: I had RP/PND at MSKCC 4 1/2 years ago. I had a reason for opting for surgery rather than RT, and hopefully you have valid reason(s) for your choice as well. I'm out 4 1/2 years now and PSA is still undetectable. I do not regret my choice. Good luck!

[crony in reply to dentaltwin]

I am not implying anything, I am telling you they have very expensive fancy facilities and recovery rooms. So like I said to them as a hammer everything else is a nail. I would not recommend anyone remove their prostate. You will end up getting radiation anyway if it escaped before you have it removed. Enjoy wearing diapers and being impotent.

[dentaltwin in reply to crony]

Degustibus non est disputandum, as they say. I am neither. Good luck!

[j-o-h-n in reply to dentaltwin]

"you said a mouthful"............Most 'fitting' for a dentist

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 04/26/2023 10:18 PM DST

[dentaltwin in reply to j-o-h-n]

Thanks John--you always make me smile!

[j-o-h-n in reply to crony]

Greetings crony, Would you be kind enough to update your bio on your home page. Age? Location? Meds? Medical Facility for your treatment(s)? Doctor(s) name(s)? Any other pertinent data concerning your history and etc. Note all info is voluntary but it helps you and will help us. Thank you!!! Keep posting.....and smiling....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 04/26/2023 10:35 PM DST

[TFU589]

Comparative Outcomes: Prostate Brachytherapy vs. EBRT vs. SBRT for Low/Intermediate Risk Disease

Michael J. Zelefsky, MD, presented “Comparative Outcomes: Prostate Brachytherapy vs. EBRT vs. SBRT for Low/Intermediate Risk Disease​” as part of a course on Prostate Brachytherapy released in 2021 and created by the American Brachytherapy Society in partnership with Grand Rounds in Urology.

grandroundsinurology.com/co...

[Hidden]

My PSA was at 12.5 and one tumor was found contained in the prostate. I was given a 4 month injection of Lupron then 27 sessions of IMRT. The first 16 sessions included the seminal vesicles. It wasn't long after the radiation and the effects of the Lupron wore off that my T started coming back and I was engaging in sexual activity again. My T has been around 500-600 and my PSA has been .2 for the last 4 years since the radiation. I'm 71 years old and I feel like the whole PCa experience is behind me. Don't do anything drastic if you don't have to.

[Volcanologist]

Here is my reply to Gus_tec with an almost identical similar situation as yours. I had 4+ PSA, Gleason 3+4 on left side apex 2 cm lesion from targeted biopsy. 2 cm lesion identified with a mp MRI pirads 5 score. I looked at all the options including HIFU and focal laser. I decided on focal HDR BT at UCLA with Dr. Chang. No side effects and had a 8 month mp MRI and no lesions 11/18/22. PSA was .89 in December. HIFU has side effects and has a relatively high recurrence. Consider SBRT or HDR BT. Less chance of side effects. I researched all of the options on my own before talking with Dr. Scholz. I highly recommend conferring with Dr. Scholz in Marina del Ray, CA. A doc friend of mine recommended him to me. Scholz specializes in Prostate oncology at all stages. He stays current on what is best procedure and treatments for various stages/circumstances. He doesn’t do any procedures, so he has nothing to sell but his advice. He knows who the best docs are for any procedure or treatment you are considering. Ultimately, he convinced me to do HDR BT over focal laser therapy. I had already ruled out HIFU, for similar reasons I dropped focal laser therapy after conferring with Scholz. Tall has good advice about SBRT. My case is very similar to yours. Ultimately, I went with HDR BT because it can be tailored to be more focal with less risk of side effects compared to SBRT, and SBRT can be done later if the HDR BT failed. However, at the right facility, SBRT or even proton therapy have very low risk of side effects. So far I have no side effects and still have an ejaculate.

[TFU589 in reply to Volcanologist]

Just want to clarify something. You did HDR...no permanent seeds?

[Volcanologist in reply to TFU589]

Yes. HDR is more potent and targeted. There is a small risk that LDR seeds can migrate out of the prostate.

[MrFireworks in reply to Volcanologist]

A Dr. Scholz founded PCRI dot org to help provide patients with information. Their YouTube channel has lots of informative videos, many by Mayo Clinic Cancer Center docs.Grand Rounds in Urology is great too.

[MrFireworks in reply to Volcanologist]

I gather that focal therapy has too high of a recurrence rate?

[TFU589]

This is a lecture series from the American Brachytherapy Society.

Yes, many hours in front of computer, but found some good info and not trying to sell you on Brachy.

( "Just the fact ma'm". ) For those old enough to remember the show Dragnet.

abslearning.learnupon.com/s...

[MrFireworks]

I had IMRT, no HT.Some tiredness, diarrhea (controlled with a small amount of Imodium) and urgency which has been fading. (We now have a pickup and travel trailer: always a bathroom handy. BTW use a towing calculator when choosing a tow vehicle; PCa is not the only risk!). PSA has gone from a high of 7.8 to 1.06, 0.71, 0.55 then 0.49 after treatment 2/2023. Slight bounce recently to 0.55, however I had done some heavy outside work just before the test.