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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,
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.
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.