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HDB Verus LDB ?

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Posted 5/30/2013 10:21 PM (GMT -5)
We are at decision time.

Dr suggest HT 1 yr, EBRT 23 dys followed by Low dose braco seeds.

I think his reasoning is because HDB is not yet approved here yet but is coming soon but not soon enough for us to have it as an option. So would have to go to another state or private. Before we get there..... Anyone have some feedback or more info on high and low.

With kids and a long haul the high dose seems a shorter treatment/recovery. I also like that if HDB fails you have the option of LDB but once you do LDB that is it.  I think the SE & Ed is better with High but not sure.

With a GS 5+3 his best cure rate is #1 of course.

Thanks you again

 

Posted 5/30/2013 11:54 PM (GMT -5)
We have similar profiles and I also combined brachy, IMRT and HT. (In fact, we're even the same age!) In my case I had HDR brachy, although it seems that's not an option for you. While I'm an advocate of HDR brachy, both LDR and HDR brachy have excellent odds of success and I'm not sure if there's any definitive advantage of one form over the other.

I do question your comment that you can have HDR following LDR brachy and not vice versa. I'm not a medical expert, but I didn't think either form of brachy would ever be followed up additional brachy if the first treatment failed. If I'm wrong about that, I'm sure others will chime in.

Most important, I wish you luck. I'm only halfway through my journey, but I'm feeling good about where I am. I'm sure you'll also do well. Please keep us posted.
Posted 5/31/2013 3:28 AM (GMT -5)
Canuck.
You are right that HDR monotherapy has excellent cure rates and possibly lower SEs and especially lower sexual SEs than LDR. There was one randomized clinical trial comparing the two done at Wm Beaumont Hospital in MI, and HDR emerged as the winner:

High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds.

But HDR brachy monotherapy is not widely available for intermediate risk PC. If not, SBRT, which is modeled after HDR, might be a good substitute for intermediate risk PC. I know it is available at Sunnybrook in Toronto (Dr Patrick Cheung).
Posted 5/31/2013 8:23 AM (GMT -5)
I looked at both, understand that both are excellent, but chose HDR due to the more advanced technology providing for better accuracy in catheter placement and more dose conformity both spatially and intensity resulting in more precise treatment to the cancer. Plus not having the radiation left in place with the normal bodily changes over the course of 90-180 days is an advantage. Another is that cancer may be more damaged by short high intensity radiation compared to the low and slow dose of LDR seeds.

Generally LDR can't be repeated due to the permanent physical presence of the seeds. HDR can be repeated and can be as little or as much as is needed.

The best website I have found for HDR info is www.cetmc.com. It is by the HDR pioneer Dr Jeffrey Demanes who has used HDR for many cancers for 30 years. He now heads the radiation treatment at UCLA Medical Center.
Posted 5/31/2013 11:19 AM (GMT -5)
This is great info..... My gut feeling is go HDB. We will discuss with RO ON Dr the question HDB v LDB. It is approved in other places but I think they are waiting to complete studies where I am. My gut is this would be better for many of the reason you all have said above. I hope to discuss this with my doctor. It may mean we pay to go to another state or go private here.
open to more info on this post :O) and feedback......

Thank you all
Posted 5/31/2013 1:41 PM (GMT -5)
Canuck,
Just wondering: Your profile says primary tumour 28 cc.
What is the size of your entire prostate?
Prostate size can affect your options.
Posted 5/31/2013 1:47 PM (GMT -5)
Canuck, back in my research days I looked really hard at both LDR and HDR and honestly I would have been comfortable with both.  There are some minor pro's and con's between the two, but nothing IMHO that would sky rocket one over the other.  I chose LDR primarily because it has a longer track record and I found one of the best LDR practitioners in the world less than two hours from my home.

JNF is right on about Dr. Jeffrey DeManes - absolutely the forefather of HDR.  I had a phone consultation with him and was making plans to fly out to do an initial consultation, and then found the CPC where I had my LDR.  I would encourage you to contact him at the CET/UCLA, I think you'll find that very helpful at this point in your journey.  Here's a link:

http://www.uclahealth.org/body.cfm?xyzpdqabc=0&id=479&action=detail&ref=109013

And if you're interested in learning more about LDR I would encourage you to get ahold of the CPC:

http://www.prostateimplant.com/

Best wishes to you as you work down towards YOUR decision for treatment.

Posted 5/31/2013 1:52 PM (GMT -5)
A Yooper
Thank you for your info. What is CPC, I don't see it in Abbrev's.
Is the consult with Dr. DeManes free?
Posted 5/31/2013 2:27 PM (GMT -5)
Sorry! CPC is the Chicago Prostate Center, they are in Westmont, IL just outside of Chicago. And yes, there was no charge for the telephone consultation with Dr. DeManes or Dr. Moran at the CPC.

If you choose to do a consultation at their facilities there will be a charge associated for that; mine at the CPC was covered by my insurance.
Posted 5/31/2013 2:45 PM (GMT -5)
Canuck, I absolutely agree with and support Yoop's comments.  I chose LDR but this was 5 years ago and there was not much of a track record re HDR.  Today I would be comfortable with either and would go with the experience of the doc rather than worrying too much about the difference betweent the two.

Jim

Posted 5/31/2013 3:56 PM (GMT -5)
Thanks guys
Just talked on the phone with RO On dr and he was wonderful. He explained it all in detail and i got 'Most of it' lol
He is doing (after ERBT) a type of high dose radiation in the long term braco pernament seeds. They have found these combination over the last 10 years has the higher success rate. I believe it is 46 grade for beam and then 110/115 grade for seeds.
His stats are 80 - 90% cancer free after 5 years for my hubby's aggressive cancer. GS 5+3
He also said there is a new study starting around the time he starts braco, and he will see if it would be a fit for him and he will look again at all the options when we get to that stage in Oct.
So we can't ask for more than that.
So after the weekend we start the HT tables and HT injections on monday.
And so it begins.......
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