ADT with Brachytherapy and EBRT

[DexterDane]

Just finished up with my Radiation Oncologist and due to the aggressive form of my Prostrate Cancer ( many core samples with Gleason 10) it was suggested I do ADT for a few months then do EBRT for 5 weeks and then Brachytherapy ( can be done with Brachy first) and continue ADT for up to 2 years. Does anyone have experience with this treatment process? what are the side effects ? any studies on the effectiveness of this treatment.

Thanks

[Tall_Allen]

It's one of the oldest therapies (since the 1980s) for high-risk PC and there is a LOT of data on it, including a large randomized clinical trial (ASCENDE-RT) comparing it to external beam (EBRT) alone, and a large retrospective analysis at top institutions, comparing it to external beam alone and to surgery (which may have included salvage radiation). The ASCENDE-RT trial included an analysis of side effects:

pcnrv.blogspot.com/2017/03/...

pcnrv.blogspot.com/2018/03/...

You should also be aware that there are two kinds of brachytherapy (high dose rate (HDR) and low dose rate (LDR)). HDR may have fewer side effects, but practitioners are harder to find.

[DexterDane in reply to Tall_Allen]

Thanks for the information it is very helpful

[westof]

So far I’ve had ADT (Casodex with Lupron(9/1/18) and now Lupron with Zytiga(4/1/19) and a side of predisone). HDR Brachytherapy (April 26th) and have completed 25 days (of 25) of RT on 7/8. Bottom line, no side effects and I feel great(YMMV). I'm being treated at Memorial Sloan Kettering and my Doc advises another 2 years of ADT. I was Gleason 9 with a PSA of 28 and now its <0.014.

[DexterDane in reply to westof]

Great to hear, I am getting a second opinion fro a a more experienced treatment center, waiting for thedate

Thanks

[westof in reply to DexterDane]

Wise move. I first went to a local hospital oncologist and he recommended 45 days of RT. I had studied other similar cases and knew I needed a more comprehensive approach. Going to MSK was the best move I've ever made. Best

[spencoid2]

Pretty much everyone agrees that the combination you mention gives the best chance of survival with Gleason 9-10 PC. I had that treatment about 6 years ago. No side effects from the radiation. All the normal ones from androgen deprivation. Look them up, you will probably get them all but they are gone a half year or so after the last shot runs it course. Did have problems with urethral contracture or strictures which got me to a local hospital ER. The arrogant poorly trained doctor did major damage to me which resulted in an emergency TURP and over two years of healing. This was worse than all the side effects of cancer treatment. I am mentioning this to make you aware that you will be more fragile after radiation and that you need to be sure that some arrogant ill trained idiot does not cause you harm. If you find that you can not pee get yourself to a real hospital where they can call in a urologist if necessary and if it seems that a doctor or nurse does not know what they are doing, get yourself out of there ASAP. You need to know the difference between a competent doctor and one who is not. I went to an ER in a major hospital after my bad experience, for the same problem of urinary retention (it was a weekend and my urologist was away) and they did exactly what they should have done. Nurse could not get catheter in but did not force it and called a urologist who arrived from far away in record time. Got the catheter in first try, went home with no damage. There is a difference in competence and you need to be able to detect the difference and not let anyone fuck you up.

Also, there is a fair chance of recurrence with gleason 9-10. Your PSA should drop to undetectable levels at some time after treatment and should stay there will a possible spike but not an upward trend. Your urologist or oncologist should be able to advise you as to whether action is needed. After about 5 years my PSA started to climb and finally got to the point that it looked like it was due to recurrent PC. I asked on this forum and an auxmin PET/CT scan was suggested. The results suggest local recurrence so a biopsy is next. I wish I had asked sooner since it has been a while with an increased PSA and gleason 9 is not watch and wait. The scan does expose you to fairly high level radiation but for just a short period. So i do not recommend it for everyone but if you are concerned about rising PSA after brachy/external radiation/ADT and your doctors agree, get the scan. I checked my radioactive emission with a Geiger counter and it dropped to nothing in about 8 hours. Pretty amazing how they control the radioactive tracer so well but there are not a lot of centers that do this scan.

[DexterDane in reply to spencoid2]

Thanks so much for sharing your experience. I now have some things to expect and to keep in mind if complications arise.

hope all goes well with this new recurrence of PC

[DexterDane in reply to spencoid2]

I did ask what the treatment would be if the PC reoccurred and was told most likely Hormonal therapy. I don't know that is the normal treatment is if PC reoccurs and I sure other men on here would know

again good luck