HDR Brachy-MONO: Who has had this therapy (MONO)??? Talk to me

It is also important to assess the urologist that will be working with the radiation oncologist.   How many has the uro done.  Oftentimes, the uro is the one actually placing the radiation catheters initially.  How long has it taken the rad onc him to do 100 procedures?   He needs to be doing these on a very regular basis, preferably several each week.   This needs to be a major focus of his practice, not an incidental one.   At the time I had HDR my uro and rad onc had teamed on over a thousand procedures and were performing about 200-300 per year.   They also had another team doing the same numbers so my radiation center was performing this procedure on a daily basis.

Did the rad onc formerly use LDR (permanent seed) radiation?   If so and he is now doing HDR,  how much experience does he have with LDR?   The initial catheter placement is similar so look at the totals of both procedures.   They have to insert the catheters fairly deep into the prostate area, but not against or pierce the bladder or rectum.   While the ultrasound guides the placement, there is a lot of feel that is involved.   That is why the doctor's experience is very important.

In the center, are there other doctors that perform HDR or is the center's total experience 100?   If the latter, then I would look to a higher volume center.   If there are others that provide HDR and or LDR than I could consider the center.   You are also assessing the physicist, dosimetrist and technicians.   They are the ones that calculate and deliver the radiation and they better be good.

If you don't mind driving a few hours (or a quick flight), a HDR master is in the Detroit area named Alvero Martinez.   He is on par with Demanes and practices at 21st Century Oncology of Michigan.  Website is www.21oncologymichigan.com.

I had HDR four years ago and it was a breeze.....I have no lasting side effects.   The answers to you questions will depend on the approach.   You are looking at the old Demanes method of an overnight stay with radiation fractions on consecutive days.   Martinez pioneered the method that Dewayne and I had (and that Demanes now offers) of doing the treatment days at least one week apart with no overnight stay.    Both work, but I think the overnight stay with the radiation catheters inserted would be no fun as you must stay immobile.   Measure that against the need for two different days of procedures.   Personally I like sleeping in my own bed and do everything I can to avoid a hospital overnight.

Issues like urinary (Foley) catheters and such will depend on the method.   Like Dewayne, my Foley catheter was removed before I went home from each procedure.   I would say that you probably don't want to be awake during the placement of the radiation catheters.   I had a spinal block and a light sedative so I was out when they inserted the radiation catheters and sewed the guide template to my legs.  They don't use an MRI.   They initially insert the catheters by ultrasound, then they fine tune the placement by CT scans at the radiation center.    You do want the CT fine tuning placement as that is a hallmark of HDR to improve the accuracy of the radiation dose.  

To me it looks like you meet the requirements that Demanes uses for mono-therapy.   I don't think HDR is too aggressive as it is fine tuned to what you need.   To me it makes much more sense than surgery as the side effects and risks are much less than surgery.

I went home with a pad as the 15 puncture wounds may seep a little blood, but I removed it when I got home and never used another....no problem.   After each procedure I got home at about five o'clock and fixed dinner for my wife and I and then back to work the next day.   I think Dewayne's activity experience was similar.  My most significant initial side effect was waiting for my legs to regain feeling and movement after the spinal block.   After the first procedure it burned the first few times I urinated.   I told my docs and they used a different lubricant for the Foley catheter for the second procedure and there was no burning.   For about a week I was tender and avoided plopping down onto a chair and avoided hard chairs.   Three days after the second procedure I drove from Atlanta to Indianapolis and back over a weekend (about 1300 miles) and had absolutely no problems.

Hope all this helps and doesn't overwhelm you, best wishes,

Jack