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brachytherapy : looking for someone to... - Prostate Cancer N...
brachytherapy
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CrackerOcala
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I had one session of HD brachy at an NCI Center of Excellence late last year - full anesthesia in an operating room. During the procedure, the oncologist delivered the targeted radiation and also placed barigel and gold fiducials. Barigel provides spacing between the prostate and rectum wall (it dissolves after a month or so). Fiducials help technicians focus the radiation beam more precisely during the subsequent IMRT sessions.
The only inconvenience was that I was one of the 5% or so who had trouble urinating afterward (they won't send you home if you can't deliver). I had to use a catheter for a couple days and then everything was fine. No pain, discomfort, or urinary issues following the procedure. I do seem to urinate a bit more frequently, but urgency isn't a problem and I still sleep through the night. Brachytherapy seems like an under-utilized tool to me. I was glad (and lucky) to find a great provider.
thanks. Helpful. What was your Gleason score prior to treatment?
Around 7, which was as high as it ever got. I had been on AS for a couple years, doing research in case the need arose. Diagnosis last fall was G4+4 and that is what treatment was based on. Lupron, brachy, and 16 IMRT sessions. Second opinion (Johns Hopkins) subsequently classified as 4+3, so Lupron is down to 6 months from 12-18.
Interested in your take on the 6 months of Lupron? Finished with it?
I tolerated my first injection pretty well and considered extending ADT as a way to turbocharge the attack. But with the second injection, fatigue is more palpable and it's a lot harder to walk a mile or go up a flight of stairs (testosterone is 7). Red and white blood counts are down and I developed neutropenia, which means lower resistance to infections. If MO strongly recommended add'l Lupron, I'd suck it up. But if he says 6 mos. is OK, I'm on that plan. Along these lines, I found this video interesting:
Also it seems various brachy patients also had a varying number of radiation sessions: 10, 26, 23 etc. How are the numbers on that determined?
Good question. I've got an appointment with my Radiation Oncologist in 10 days and this question is among the many on my list. I suspect that Gleason score, number, size, and location of tumors, CT and MRI scans, etc. are part of the equation. In my case, I'm curious about how the total number of Gys delivered by brachy and IMRT was determined.
I had one HDR session followed a couple weeks later by 23 EBRT sessions. So can’t comment really in HDR effects. But process was relatively easy. Rolled into room just before lunch, not sure when I woke up in recovery, but slept a while and was one of the last sprung that evening about 7ish due to urination tests that were inadequate. Hard to keep producing quantity when you haven’t eaten in 20 hours or had drink in 12. Had pad walking out of hospital, a little blood from punctures but not much really. Next day pretty much back to normal. They inserted fidiculs while there for the EBRT later. Few days prior was on Flowmax and another drug I forget. Regular NSAIDs after (Tylenol?) but really didn’t take many. Really noth8ng to worry about from my experience.
I had HDR brachy at UCLA last year April with 10 day follow up external beam radiation.
I’m struggling with some minor ED issues but Viagra has been mostly good.
I have a very loving and understanding woman in my camp.
PSA has been 0.02 so far.
thanks. What was your Gleason score prior to treatment?
thanks. What was your Gleason score prior to treatment?
thanks. What was your Gleason score prior to treatment?
It was 9.
Thank you. Also it seems various brachy patients also had a varying number of radiation sessions: 10, 26, 23 etc. How are the numbers on that determined?
23 EBRT sessions, 2 week rest, then 68 low does brachy seeds implanted. Was on ADT for 18 months. After the EBRT and brachy was getting up A LOT in the evening. Helped to take my two tamulosin doses together before bed. Took a few months for that to settle down. Urination good now. Need the Vitamin V to help with sex but it's ok
thanks. What was your Gleason score prior to treatment?
Gleason 4+5, isolated to prostate.
My husband had LD brachytherapy in Jan 2023. No other treatment besides. PSA 6.6 at diagnosis. PSA density 0.23. Gleason 4+3 intermediate risk. Normal size prostate. 75 seeds implanted. Side effects immediately after were urgency on standing, irritation on passing urine, minor retention after sitting for periods & in the mornings on getting up. Took Tamsulosin , eventually weaning off it at 9 months. PSA now 1.2. Slight slow flow if gets up at night (about every other night & less than before treatment) & occasional urgency during day managed by going regularly. Has been informed indicative cure of disease at last review.
I had LDR brachytherapy and did very well and would recommend because it is one and done. I luckily had minimal to no side effects, and doing great two years later. Not everyone can qualify however. Please check my posts.
thanks. What was your Gleason score prior to treatment?
3 +4=7, favorable intermediate.
Happy with my decision. 5 treatments in 5 days 5.5 years ago at MSK/West Harrison, NY. Little or no side effects then and none presently.
thanks. What was your Gleason score prior to treatment? Five rounds of brachytherapy?
4+3. Yep, 5 high dose. Also, used the OAR.
You getting HD? Are you going to Moffitt?
I’m in FL. Checking out my options by asking ahead of time. How did u deal with your prostate cancer? Brachytherapy? What was your Gleason score?
Yes, I know. I live most of the year in Palm Harbor. If you read my profile you'll see everything there. If you choose HDR brachy I would highly recommend Dr. Dan Fernandez at Moffitt radiation oncology, he's outstanding. I would be glad to answer any questions you might have.
I received low dose brachytherapy at the Dattoli Cancer Center in Sarasota in 2017. I was given an epidural and relatively mild anesthesia; unconscious but just enough to allow the procedure. The radioactive seeds are placed through the perineum. I stayed in the hospital overnight with catheter in place. Its removal was a briefly painful. I was able travel that day. Overall, a very tolerable experience. I had nearly 50 radiotherapy sessions just before that. My Dx was stage 4, Gleason 8. PSA declined fairly quickly to undetectable and has remained there ever since. Dattoli specializes in Brachytherapy through their institute of the same name. Best luck in your situation.
Than you. How was the decision reached to do brachy after already 50 rounds of radiation?
So 50 rounds was determined to be insufficient!?
In 2018, my PSA was 5.2. Biopsy revealed cancer. Gleason was 4+3=7. I had 2 sessions of HDR Brachytherapy at UCLA in May 2018. Subsequently, I had off and on pain in my penis for 2 years. From September 2020 to January 2021 in addition to the penis pain I was passing blood and small blood clots in my urine . My UCLA urologist scheduled me for CT scan and cystoscopy thinking it might be bladder cancer. Neither test found cancer. In January 2021 I had two episodes of Acute Urinary Retention. You can't pee. Incredible pain. After each episode I was sent home from the doctor's office with a Foley catheter and leg bag which resolved the pain. When it looked like the retention might be long term the urologist had me doing intermediate catheterization. Fortunately the blockage that caused the urinary retention resolved itself and I started peeing normally. In February, 2021 I was diagnosed with Radiation Cystitis and Radiation Urethritis. This is concerning because it could cause the Urinary Retention to reemerge. I was originally told by UCLA radiation oncology that the goal is to keep my PSA number under 1.0. From March 2019 to June 2023 my PSA met the goal, but from June to December 2023, it elevated from .86 to 1.49. In a second blood test in December it was 1.12. I conferred with my urologist and it was decided that I would have an mpMRI. The MRI indicates that the cancer has reoccured. The MRI report recommends that I have a PSMA/PET/CT scan. The PET scan is scheduled on March 11 at City of Hope.
Wish you the outcome possible.
best outcome possible.
Gleason 9, aggressive, PSA 20.6. I had two High Dose Brachy sessions in March 2016, a week apart. Awake for it all. Spinal tho. Went home with catheter that both times plugged up 6-7 hours later. Self removed catheter each time. Literally no issues other than sore. Was interesting that they left the room after setting me up.
So no external radiation involved? No hormone block? Thanks for sharing.
How was it determined that the two sessions had sufficiently stopped the cancer?
My RO is the Chief of Radiology and has a PhD in microbiology so it was her call .
My answer was related to HDR Brachy Before that 25 sessions of IMGRT, external, and during all that 24 months of Lupron. Now almost 9 years later on holiday from Nubeqa,34 month of treatment with Lupron. PSA naidr <0.02 for 30 months. Stopped all treatments Jan first this year.
Thanks Teacherdude . . Now I am curious to know why the docs switched you to Brachy after 25 sessions of Imgrt? How was that decision arrived at?
Didn't switch that was the plan all along. Both combined have better results. I was G9, aggressive so the treatments were aggressive too. PCA came back so not a cure.
Back in September 2017 I had a guided (fusion) biopsy where one of 14 cores indicated GS 8.
I chose the RT which involved EBRT followed by brachytherapy without HT. At BCCA in Vancouver it was 'optional' to have HT with my low PSA of 5.2 and just one core showing cancer and T1c. The EBRT started in Dec 2017 and the BT was on Feb 1st 2018.
Ten days before the brachy I had a spicy Mexican dinner and developed proctitis. This resolved itself just before the seeds were implanted.
Other than two big PSA bounces everything went to plan. However, I did have blood in my stools starting in 2019. This was ongoing every 10 to 14 days. In November 2021 I had argon plasma coagulation (APC) and again in March 2022. After the first APC for about a month I was in pain after my two to three bowel movements each morning. I told the doctor this before my second treatment and he said there were no pain receptors 'down there' so he was surprised. He prescribed lidocaine with the second APC which was never needed.
The PSA bounces triggered a PSMA scan which found no hot spots. My PSA is now checked yearly with the last PSA of 0.089.
Other than paying 'out of pocket' for the MRI everything was covered with the government health insurance. I could have waited a year for the MRI and not have paid for it. Had I waited a year things may have been different.
Thanks Demarco. What type of brachy did you have? I assume not much went wrong with that as nothing was mentioned. And regarding the external radiation were there ill effects? Thanks again.
I had LDR and afterwards I experienced burning when urinating which stopped after a long walk . The EBRT gave me proctitis that lasted about a week.
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