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Re: Brachytherapy vs. IMRT

I attended a Prostrate Group meeting last year. The speaker discussed both and it sounded like Brachy ( according to this radiologist anyways ) has advanced due to the use of new gold markers to a success rate "equal" to radical. Big improvement in past 3 years he said. I think I would have gone that route ( brachy ) 4 years ago but at that time radical had the best long term success rate for lower grade prostate cancer so I went with it. Hope that's helpful.

Re: Brachytherapy vs. IMRT

John, Bobby and Terry: thank you all for your comments. I just set up 2nd opinions for all options for next week. I am still leaning toward the brachytherapy and am trying to get used to the idea of actually going through it! I feel fine - no effects from the pc. As I said, it was discoverd while my psa was very low. AS is not an option in mind: I do not want to live with the disease and at age 46, even if I wait, it will only narrow my choices (perhaps) as time goes on. I have a 90%+ cure rate after 10 years by doing most anything now and I am going to accept that and move along. The radiologist I saw has done 1250 IMRT or Brachys between 1998-2009. He does at least one a week (brachy) and has a high 90% success rate (10 years). He has 76 brachy's on men age 50 and below and ony 3 have had a recurrence.
I would still like to hear from someone who had brachytherapy with seeds done (preferably young like me) but I am sensing surgery has been the predominant option. Any Brachy veterans out there that can tell me what I may be in for?

Re: Brachytherapy vs. IMRT

David, I'm not a brachy guy, but I am young (44 y/o) and recently completed Proton Beam Therapy (PBT) treatment, which is a form of EBRT. IMRT is a close cousin, although theoretically at least, PBT is said to be safer due to the use of protons vs. photons (i.e., protons offer the same radiation dose to the target area but a lower dose to surrounding tissue due to the "Bragg Peak" effect).

I would highly recommend you consider PBT as part of your research before you choose any given treatment option. PBT is very effective (~95% cure rate for localized, low-risk PCa) and likely has fewer side effects than even IMRT. The advantage over brachy is that with PBT, you get your treatments and that's it -- you're done. With brachy, the radiation source remains in your body (a fact which unsettled me since I have a wife and young children). I received 39 treatments over 8 weeks, for a total target radiation dosage of 78 Gy. It is a time sink but worth it in my estimation; my boss let me work remotely during the time of my treatments, even though I wasn't incapacitated or anything. The results so far have been outstanding: My PSA is dropping like a rock and I have zero side effects (urinary or sexual).

Best of luck to you in whatever course you select for yourself. There is one thing you and I already agree on -- At our "tender" ages, AS really isn't a viable option.

Re: Brachytherapy vs. IMRT

Thank you Scott! I am going to look into that as well. I am curious as to when you had it done. I noticed someone else on the site who had it done but a year later his PSA has started climbing again. That gives me pause but again with so few cases documented and for me to draw upon, any info is critical in my final decision. Our local Cancer Center began offering it last year (one of the 10 centers across the country). As it turns out, my second opinion is next week with a rad onc at that very same hospital. It is on the agenda and at the top to discuss.

Re: Brachytherapy vs. IMRT

I had it done from August-October 2011 at MD Anderson in Houston. It was a breeze, with the rectal balloon being the only minor daily inconvenience. Just this week I had a follow-up, and my PSA has already dropped 65% from the level I had immediately pre-treatment. My radiologic oncologist called it "quite good," which caused me to beam from ear-to-ear.

Please give proton therapy a hard look. I spent probably 200+ hours researching every possible treatment alternative under heaven (all forms of RP, all forms of EBRT, brachy, HIFU, Indian shamans :-)), before landing comfortably with PBT. I don't regret my decision for a moment.

Re: Brachytherapy vs. IMRT

David ... go to "Treatment Experiences" and look up Phred X ... that'd be me.

I had both seed implant and external beam radiation back in 2007 and there have been ups and downs since. I'm on hormone therapy (ADT) now and doing well.

Hindsight being 20/20 I cannot say I'd do it again but others in this category haven't had the same experience that I did. Check it out and good luck.

Re: Brachytherapy vs. IMRT

wanted to update all here who have responded. First: Thank you for taking the time to reply. It is very helpful knowing there are others out there that have been where I am at present. A couple of you live in my hometown and I do plan to call you at some point to get the real scoop on what your treatment was like. In the meantime, I met with a RAD-ONC today (he spent almost 2 hours discussing with me and my family the options!). He seemed genuinely disturbed that my urologist even felt I needed a biopsy with a 2.9 PSA but as he said, "since pandora is now out of the box, you will want to do something." He felt that since I am young, I should get an MRI to better reflect the tumor or tumors present to see what I am really facing. He said I have very slow growing type and I can truly take my time to decide what to do - a far cry from what my urologist told ("You have weeks to make a decision"). He said my current doubling period is 10 years. I guess I am thankful I know what I have and that I can be proactive and not reactive. Tomorrow I go to see a different urology surgeon to get his take on things. Then i can sit back and digest everything. I am set up for the MRI so at least I will have a baseline and the RAD-ONC can tell me exactly what the tumor(s) look like and how I should respond. He suggested I might be a candidate for a new IMRT method using only 5 sessions instead of 43 but using a higher dosage. Anyone familiar with that? It's being used (with success) at Stanford, Michigan and elsewhere although I would be the 3rd in my town. Shorter treatment period equals less side effects (so far) that they have seen. Again, thank you so much for just being there as a sounding board. I would say you don't know how much it means but I know you all do!

Re: Brachytherapy vs. IMRT

David,

Sorry, I can't answer your questions, but instead, offer the following...

When I went thru the decision process, six years ago, I was told that any sort of radiation treatment (brachytherapy, beam, etc), as a primary treatment potentially eliminated salvage surgery as a secondary treatment, should the need for secondary (or follow-up) treatment arise.

I don't know if radiation treatments have been refined to eliminate the radiation scarring that caused salvage surgery to be so 'ify'.

You may already know, or you may want to ask this question of the medical experts you are consulting.

It might assist others if you could share the answers here.

At any rate, All the Best!

Danny

Re: Brachytherapy vs. IMRT

Thank you for your kind words, David. I know that you are not alone in appreciating the input from all the Yana men (and a few of their women).

The practise of using higher but fewer radiation doses is termed Hypofractionated Radiation if you want to search around for some references. Using the Site Search Engine and that phrase will bring you some links as will IMRT. The best known of the current hypofractionated radiation therapies has a registered trademark and is marketed as CyberKnife

Many of the claims made for hypofractionated radiation seem not to be supported by good independent studies and evidence of its claimed superiority. On the other hand, as one of the sites I found said, it does have the potential of creating a much better throughput for the radiologists since they can treat about five or six times the number of patients in the same time span.

Good luck
Terry in Australia

Re: Brachytherapy vs. IMRT

Two years ago when I was initally diagnosed with low risk GS6 cancer I was talking to Dr Lee at Duke. At that time they were starting a trial where they would reduce the normal nine week treatment (45 treatments) to a two weeks (I believe it was only 7 treatments), but at a much higher dose. At that time I opted for AS so I didn't join the trial. You might contact Dr Lee at Duke to see if they are still offering the short IMRT protocol.
Recently I finished proton treatment at UFPTI where they were giving guys with low risk PCa the chance to try 29 treatments over 6 wks at a slightly higher dose instead of the normal 39 treatments over 8wks. I heard early "scuttlebutt" (Navy speak for rumors) that the shorter treatment seemed to be yielding similar results as the longer one in early findings.
As Terry alluded to: "Medicine is a business, and the purpose of business is to make money." The shorter the treatment cycle, the more patients can be treated, and the more money can be made. Also I think the heath care industry can see the handwriting on the wall that the cost of Medicare and other health services must be reduced in the future.
Oddly enough, during my stay at UFPTI, I talked to a lot of fellow patients, and most opted to stay with the 8wk plan especially if they were retired. The ones that opted for the 6wk plan seemed to be those guys still working or who could not be away from home for the additional time.

Re: Brachytherapy vs. IMRT

Joe (and all): I was offered a similar treatment here in my town - only with a new study that is only 5 total treatments. I have chosen not to do this because it is a trial and in meeting with a surgeon, I had my "A-HA' moment. I had been looking for a less intrusive way to handle my condition but a few other factors have opened my eyes. I have bilateral kidneys and both reside very securely by my hips and not up further where most people have them. When I met with the rad-onc last Thursday he said I would probably be okay but he could not guarantee that they would not recieve some "scattered" radiation. That concerned me although perhaps it shouldn't (I am diabetic - controlled by diet and exercise). The next day I went to see the surgeon at the same hospital. He was unlike most any other surgeon I have encountered. He took his time, laid out all options including radiation. A couple things really caught my attention. When he took a look at the CAT SCAN I had done, he got really curious and probably spent about 15 minutes just showing us frame by frame the entire scan. He was really interested in the kidneys but said that should not be a problem with Da Vinci from his perspective. Second - and most important - he said it is younger guys like me that make the good results on ED and long term incontinence go up. The younger patients by and large (with him anyway) have had very few SE and it is the older patients that bring the numbers down. He also mentioned that it would not be fun and he did not sugar coat anything - going so far as to describe the catheter (which I actually fear the most) but assuring me it hurts more going in but that I would be deeply asleep at that point. He has done over 2000 PC removals and around 400 on Da Vinci. He also had a sense of humor (which is very important to me). We sat down and went through a Sloan Kettering program which basically graded me 98% cancer free in 10 years. And it was around 90% in 20 years (equal to general population). Radiation could not give me that assurance b/c it has not been around that long. So now I am researching surgery - the one thing I really did not want to do! Anyway I look at it, it's going to be a pissy month or so (pun intended)- whatever month I choose. The next step is up to me. Sigh.

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