The markers, called fiducials are very tiny - the size of rice grains, and they only implant 3 or 4. You won't know they're there. Yes they are necessary to prevent radiation toxicity - they tell the radiation exactly where to hit or where not to hit.
The latest innovation in radiation therapy is called "hypofractionation." That means a full course is delivered in only 20-30 treatments. Because it's new, not everyone does it. Here's some info about it:
The kind of radiation with the highest cure rate for guys with your diagnosis is called "brachy boost therapy." It combines a shortened cycle (about 25 treatments) of external beam therapy with a brachytherapy (seed) treatment. Unfortunately, it's not available everywhere. I think UCDavis might offer it. The downside is that urinary side effects can be much more troublesome, and at 84, it may compound any preexisting urinary problems.
Protons have never been shown to be any better than X-rays. They are neither more curative, nor less toxic (in spite of their hype). It is a long series of treatments and is much more expensive - insurance may not cover it. Sexual problems seem to be worse with protons.
Try UCDavis, UCSF and Stanford. I should also mention that if you want to look into brachy boost therapy, you can have the brachytherapy part done at a specialist location and the EBRT done nearby.
Tall_Allen, with respect to the question of whether these markers might be harmful, how about the surgical clips that are often left behind after prostatectomy? Might these cause harm during anal intecourse?
They are also very small. After a few months, the blood vessels they are attached to should have healed, so I don't see what harm they can cause. Of greater concern is the anastomosis - the stitches there can rip with a heavy bounding. it's a good idea to wait at least 3 months before any rough sex. If something hurts (in an unfamiliar way), stop.
Hi David, I have had 72 radiations over the past 12 years. It was explained to me that the little flecks of gold were placed in such a way that the radiation machine could read them in 3 dimensions and know exactly where my prostate gland is when I lie down on the table. Sometimes poop goes down the intestine during radiation and moves the cells away from the focus of the beam. (The prostate is not attached to a bone and can move around) The radiation machine can move with the cells, or immediately shut down so that healthy cells are not bombarded. Also when you return for your next radiation the machine looks for those markers again. It is not a perfect system and mistakes do happen. I had my colon open up and had e-coli in my system and went into sepsis. You see the beam is a tiny beam that goes in a straight line through your body. You get three shots at each visit from different angles, and where the beams cross over time will kill cells in that area where the beams most often cross. So I had 42 radiations (which is 126 beams from different angles). After 4 years my PSA went up to 72 and I was Stage 4, so I had 30 more (90 more beams). Each beam last about 4 - 5 seconds and comes from different angles. At that time I started Lupron with 3 weeks of Casodex. It has been 7 years now and my PSA has been 0.00 every since. I have no idea where the tiny flecks of gold are, but am sure they are still there. Great questions, keep them coming!
For me the markers are benign. They are just black ink dots used to line up the radiation equipment. I do not know anything about proton radiation sorry.
You might consult Dana Farber in Boston, which offers image guided focal brachytherapy to remove only the tumor. Or Sloan Kettering in NY, or MD Anderson in Houston both of which offer a variety of advanced imaging and focal treatments.
Like you, my Gleason score was 8. My PSA varied between 12 and 20. I was recommended radiation and hormone deprivation once, and RP and hormone deprivation twice. I finally went to MD Anderson, which determined that there was no spread, and no evidence of remaining cancer after TURP. I still have all my bits in a functional state, my PSA (checked again yesterday) is down to 1.5, lowest it's ever been in 20 years of annual screening, and the VA is going to cancel my disability check if it stays that low for another 18 months. Maybe I'm an outlier, but I'm not a fan of radical and systemic treatments based on educated guesses.
Hi Sloan Kettering in NYC uses what they call Precise, which is a targeted radiation approach with just a few treatments and it also includes one brachtherapy treatment.
Alternatively, another approach would be CyberKnife, which is also a radiation approach with 5 treatments, each around 25 minutes and is very effective, albeit it does not necessarily include pre or post brachytherapy. A Google search would probably help determine if there is a medical center near you could reach out to for more details. Wishing you good luck!
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