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HDR Brachytherapy plus General Beam Radiation versus Surgery?

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Posted 12/5/2018 5:10 PM (GMT -5)
I've recently been diagnosed with PC (PSA 3.8, Gleason 4+3).

I'm looking to find advice about two treatment options I have been offered - HDR brachytherapy followed by general beam radiation or radical laparoscopic robotic assisted prostatectomy.

If you have any good or bad experiences with HDR brachytherapy (which I'm leaning towards) that would be helpful as well as the benefits or risks of surgery.

Many thanks
Posted 12/5/2018 8:40 PM (GMT -5)
I had LDR brachytherapy with external radiation. Not much difference between LDR and HDR as to effectiveness and symptoms. No side effects after 10 years and psa less than .05
Doubt I would have have the same results with surgery.
Posted 12/5/2018 8:55 PM (GMT -5)
I had HDR+IMRT eight years ago for high risK G7 . Complete cancer control and no negative side effects. In my opinion and experience this is the best way to go.

Let me know how I can help.
Posted 12/5/2018 9:14 PM (GMT -5)
Thanks for the updates and great to hear it is working so well.

JNF it looks like you had the IMRT (general beam radiation therapy) done before the HDR brachytherapy.

The radiation oncologist here in Ontario is planning to do the brachytherapy first and then the general beam. Fortunately I do not have any spread outside the prostate.
Posted 12/5/2018 9:55 PM (GMT -5)
Great option. I chose SBRT but would have chosen HDR/IMRT with a slightly different biopsy. Good luck!
Posted 12/5/2018 9:57 PM (GMT -5)
I'm not sure the order matters, but the combo will do the job and you should do well with it.

IMRT is a bit of an endurance test, but most do well with min SEs. I have a little urgency, some bowel issues and a tendency to write poetry and a result.

Andrew
Posted 12/6/2018 7:09 AM (GMT -5)
That is a fairly normal sequence. Mine was concurrent as I had the two HDR procedures about 2/3 of the way through the IMRT fractions. Some docs claim a better effect that way.

You will do very well with this protocol.
Posted 12/6/2018 10:04 AM (GMT -5)
HDR alone with good results here. I had fairly quickly decided against surgery and eventually decided on HDR for my radiation therapy. I might've gone with SBRT but had been warned it might not be approved for me by my health care provider, given my GL 7 status. Wonder if 3 1/2 yrs on, and with more studies completed, if SBRT would now be routinely approved for my status?
Posted 12/6/2018 10:35 AM (GMT -5)
I recently completed 2 HDR treatments combined with 28 IMRT treatments. My HDR treatments were completed one week apart midway through the IMRT treatments. I spent 5 months learning about the different treatment options and speaking to multiple surgeons and radiation oncologists before deciding on HDR/IMRT. I found the treatments to be routine and the temporary side effects manageable. I am 5 weeks out from my last treatment and I feel good. I would consider the HDR/IMRT to be a good experience for me. My advise after going thru the process would be the following. Take your time and do your research on each of the treatment options. Be your own advocate and talk to as many people/doctors as you need to get comfortable with your decision. Once you decide on your treatment option, find the most experienced surgeon or RO for that specific treatment. Good luck with your decision and if I can help in any other way let me know. - regards Mike
Posted 12/6/2018 9:03 PM (GMT -5)
SBRT is getting to be routinely approved.
I was an unfavorable GS7 but was approved.

Roger
Posted 12/7/2018 6:05 PM (GMT -5)
I was all in for radiation until both General and Proton docs required Lupron. Perhaps since one of my 3 lesions was near a seminal vessicle was the reason. Surgery scheduled for 1.15.2018.
Posted 12/7/2018 7:27 PM (GMT -5)
Roll of the dice with any procedure, I guess, but I regret getting the surgery. Huge amt of pain post-surgery that led to a few emergency visits. Catheter scarred me, led to stricture which had to be repaired by a urethroplasty op. with it's own issues.
Posted 12/7/2018 11:20 PM (GMT -5)
Why open surgery in 2017?
Posted 12/8/2018 4:03 AM (GMT -5)

TEBOZO said...
Why open surgery in 2017?

open prostatectomy versus robotic procedure each has their own advantages and disadvantages. open was free for me so that made the choice easier smile Urologist that treated me did both types and said his only preference for the robotic was he sat down more.
Posted 12/8/2018 12:40 PM (GMT -5)
Where and who did your open surgery?
Posted 12/8/2018 7:51 PM (GMT -5)
I'm about 4.5 years out from treatment with HDR and beam radiation along with a six month dose of Eligard. The beam radiation was given over three weeks and then the HDR was give in two sessions separated by maybe a week. The worst part of the treatment was the Eligard.

Immediately after treatment, I had with erectile dysfunction and frequent, urgent urination. The erectile dysfunction resolved within about a year. I have very little ejaculate but no lost of sensation at orgasm. The frequent urination took maybe 4 years to completely resolve to no bedtime visits to the bathroom but was never a big problem. I had one event of blood in urine a couple of months ago after a day filled with physical exertion. I had a bladder scope and the doctor said that my blood vessels in the bladder are fragile due to the radiation. My current PSA is 0.06.

Best of luck and let me know if you have any questions about my treatment.
Posted 12/9/2018 1:19 PM (GMT 0)
Your treatment choice may vary depending on whether you prioritize survival or side effects. For young and healthy men with high-risk localized PCa they have better survival with RP compared with EBRT + BT. See this study Comparative Effectiveness of Radical Prostatectomy Versus External Beam Radiation Therapy Plus Brachytherapy in Patients with High-risk Localized Prostate Cancer
My own experience is that with an experienced and skilled surgeon, side effects are limited and tolerable. Good luck whatever treatment you select.
Posted 12/9/2018 7:05 PM (GMT -5)
High Risk Localized? therein lies the rub
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