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EBRT vs. EBRT + Brachytherapy

There seems to be a growing trend in radiotherapy toward dual mode treatment with IMRT followed by Seed Implants.
There are some doctors making claims of better results vs. an aggressive course of IMRT alone. The cure rates claimed by some of these doctors are rather extravagent even in high risk patients.

I asked my radiation oncologist if I might be a candidate for this and he said he felt my best option was for IMRT only.

I am wonder what differentiates who is a good candidate for dual treatment and who is not.
Is there some physioligical feature of the disease (such as stage) or anatomy (such as a very large prostate) that dictates this?
Is it just a matter of the preference or philosophy of the individual doctor?

Tony
USA

Re: EBRT vs. EBRT + Brachytherapy

Tony,

As far as I know there are no long term studies that demonstrate conclusively the better outcome of either of these options.

As you surmise it comes down to the views help by individual medical practitioners.

Good luck with whatever you choose

Terry
Australia

Re: EBRT vs. EBRT + Brachytherapy

Tony ... I had the seed implant prior to beginning five weeks of EBRT.

Both my Urologist and my Oncologist (+many related websites) said that there are, in fact, qualifying features for SI ... enlarged prostate ranking up there with no metastasis.

I had to take five months of hormone therapy (monthly Lupron injections) in order to reduce the size of my prostate.

There is lots of internet material on this subject, read em but be careful which ones you believe.

My personal experience

was I received IMRT. My Urologist and Oncologist discussed seeds but in my case (PSA 10.5, Gleason 3+4=7, Staging T1c, negative bone and C-Scan) it was decided that IMRT alone would be sufficient and the seeds might be difficult since my cancer was located in the lower left apex area with a 3% involvement of cancer). I had four biopsies (51 samples) over a about a three year period and the cancer was only found in the lower left apex.

Since my IMRT, my PSA went down to 1.8, elevated to 2.1 and 2.3, and just the other day back down to 2.0. So, I am still hoping for a further decline in the PSA. My case is hard to define perhaps since the PSA never went down below 1.0 yet, but also never elevated much and has gone down. This after 9 PSA tests over a two and a half year period.

My guess it is a doctor's call whether you get the seeds and external radiation. My doctor is a very highly regarded Urologist who probably could have made more money with seeds and/or radical prostatectomy but he recommend IMRT and the Oncologist out of Fox Chase agreed. I, after careful consideration went along with their recommendations although the Urologist told me he would perform the operation if I elected for it.

Good luck and best wishes for successful treatment in whatever you choose.

Chuck
PA-USA

Re: EBRT vs. EBRT + Brachytherapy

My choice is already made.
I am now 30 treatments into a 45 session course of IMRT.

My Radiation Oncologist said that dual mode radiotherapy was not planned for me and that I would receive IMRT only.
He just didn't say why.

It's not that I'm worried about it.
I know that IMRT is a valid treatment.

It's just that I am a high risk patient and I want every advantage I can get towards a cure.

I would like to believe that I'm receiving the absolute best treatment that medical science has to offer to an individual in my situation.

I would not like to believe that I'm recieving treatment based on the luck of the draw, getting only what this particular doctor has to offer based on his personal preference or capability.

Re: Re: EBRT vs. EBRT + Brachytherapy

Your concerns are my concerns. We live in a rural Alabama area. It has been a comedy of errors so far and I just want to take my husband to another area. The bx is next week. PSA 12.4. I am afraid of the care around this area. I dont know where to turn. I am having a hard time trusting these people. Hang in there. These forums sur do help! Good luck to you.

Re: Re: Re: EBRT vs. EBRT + Brachytherapy

Christina,

I know that Terry does not permit advertising here, but contact Dr. Clint:

Clint Holladay, MD
Baptist Medical Center
Birmingham, Alabama
205-783-3243

Dr. Holladay did my seed implantation on January 27, 1998 while working at the Radiotherapy Clinics of Georgia. I couldn't be happier with the results.

While reviewing my post implant dosimetry with Bobby, the head radiation physicist at RCOG, Bobby said, "He has magic hands". I could see for myself just how precisely he placed my 108 seeds in my prostate and the additional 15 in my seminal vesicles. As I went through layer after layer of the scans, I could wee how he placed seeds in circles around my urethra to prevent it from becoming damaged. Likewise I could see how he "pulled them bacK" from my erectile nerves, which is one reason I have no impotence problems.

Jack Jennings
Undetectable PSA at 10 years out in sicklerville, NJ USA

Re: EBRT vs. EBRT + Brachytherapy

I honestly believe that skill has much to do with success rates and....it's never too late to start asking questions. Good luck (Alaska, USA)

Re: Re: EBRT vs. EBRT + Brachytherapy

Pat's post hits the nail directly on its head. The skill of the doctor (and his helpers) is of paramount importance in ANY prostate cancer treatment. Taking the topic of this thread as an example, brachytherapy is an extremely difficult procedure to do right, and unfortunately many seedings are done poorly. The radioactive seeds are inserted in the prostate using needles, and when the first needle is inserted in the spongy prostate it is distorted, with further distortion caused by each subsequent needle. The doctor must have and excellent sense of spatial perspective to place the seeds in this distorted mass so that they are in the correct places when the needles are removed. When done correctly, seeds can deliver the most radiation to the glandular tissue of the prostate (the only tissue that becomes cancerous) while not excessively irradiating other organs (like the bowel and bladder). In my case the seeds alone implanted in my prostate delivered 12,000 cGy of radiation, mostly to the prostate itself, with little leaking out. Since I had a Gleason score of 7, with the associated increased likelihood of extracapsular extension, I also had 35 additional treatments of conformal external beam radiation aimed at both the prostate itself, but also the area surrounding it. (this was before IMRT). Each treatment provided 150 cGy of radiation for a total additional dosage of 5250 cGy. This beam radiation had to be delivered accurately to minimize damage to my bowel and bladder, which it was. I had only minimal side effects during and immediately after treatment and have absolutely NO side effects now, ten years after treatment. I enjoy a PSA that remains undetectable (got my ten year report today) have no urinary or bowel problems, and enjoy a wonderfully exciting sex life with my loving wife.

I am often asked why I underwent such a high dosage of radiation. It should be noted here that the dosage from seeds (mine were I-125) and from external beam radiation are not exactly equivalent, because the energy of the gamma rays produces are a little different). It should also be noted that the highest dose that can presently be administered using IMRT alone is about 8400 cGy before associated morbidities become bad according to Dr. Zelefsky, a pioneer in the field.

I viewed my prostate as having some cancerous cells, with the rest that could become cancerous. I also suspected that some might have escaped the gland but were still in the vicinity. I wanted them all killed. I also learned that nobody really knows how much radiation it takes to kill cancer and that some prostate cancers varieties are radiation resistant. I was also convinced that it is best to be treated just once and not need salvage therapies later.
Hope this helps,

Jack (USA)

Re: EBRT vs. EBRT + Brachytherapy

I have done further research since my original post.
It appears that the treatment I am receiving is the most appropriate for my circumstances.

An article in the Prostate Cancer Research Institute newsletter states that IMRT alone is better suited if the cancer is suspected to be outside the prostate.

If it may be in the seminal vesicles or prostate bed, a full course of IMRT is indicated. This is also the preferred technique if the patient is to receive "whole pelvic" radiation to include the lymph nodes.

My PSA at diagnosis was very high and my Gleason score was 7. I have received 25 treatments to the pelvic region and 20 more treatments for prostate only boost. The total will be 8100 cGy.

Even with the wider "whole pelvic" fields, the side effects have been minor. Considering how much dosage I am getting that's pretty remarkable.

I guess I am getting what I need, and I'm thankful that I am not experiencing the difficulty that some men get when the seed boost is included.

I just take nothing for granted and insist on knowing exactly what the doctors are doing and why.

Re: EBRT vs. EBRT + Brachytherapy

Good to see you back on WWW, Jack and to read how well you've done over the last ten years.

Just to clarify one point. Although my header said that I would not allow commercials, I don't regard a recommendation from someone, based on their personal experiences as a commercial.

I've altered the header to reflect this, but thanks for mentioning it.

Re: EBRT vs. EBRT + Brachytherapy

Hi Tony,

I think you ARE getting the best possible treatment.
I believe my 37 RT treaments were delivered with total accuracy. I had seminal vesicle and pelvic wall involvement, and like you was high risk....PSA 182, T4 tumour.
Of course, I also had hormone therapy, but all that ended after 30 months, and now, 20 weeks of no meds at all see me with a PSA of still less than 1.0 while my testosterone has risen well, now back in the normal range at 20.

Very Best Wishes,

George

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