HDR Brachytherapy treatment recovery process?

Two lesions, one left 3+3=6 , one right 3+4=7. 16 cores, 5 cores with carcinoma, no perineual invasion or lymphovascular invasion. PSA 7, Polaris score of 3.1, Decipher score of 0.50. Haven’t been on active surveillance, process with insurance (denials) has taken forever. But that’s another story. My first Brachytherapy is scheduled at end of month, then second two weeks later.

Let me step in and explain why I considered HDR Brachytherapy as an alternative to surgery.

When I was diagnosed at Moffitt Cancer Center in Tampa, Florida with low risk Decipher, intermediate Gleason 7 cancer confined to the prostate, I was offered surgery, various photon therapies and HDR Brachytherapy. Moffitt's Proton therapy won't be available until 2026, so they never discussed it. If I had stuck with Moffitt, I would have chosen HDR Brachytherapy, trusting in their ability to deliver it accurately. The way I understood it, they would sew a temporary plate to my perineum with guide holes for the many delivery tubes that would be inserted into my prostate at predetermined locations. This would be done under a spinal block of some sort. Once tube placements were confirmed by imaging I would be taken to a treatment delivery room where a computerized machine would insert, retract, and repeat the process for all inserted tubes. The radiation seed would be precisely exposed for a predetermined time at the end of each tube and then retracted to be inserted into the next tube, etc. When finished, the plate and tubes would be removed and the whole process repeated one more time a couple weeks later. So with this therapy, you expose nothing outside the prostate to radiation, as you would with both photon therapy and to a lesser extent, proton therapy. If accurate (and you have to trust the science here), this treatment should leave you with fewer side effects than surgery, where you risk the dangers of anesthesia and surgery, snipping out the prostate and other tissues, including a section of your urethra that must then be stretched and reattached to the bladder neck, etc. So it only takes two days of treatment with HDR Brachy, two weeks apart. But I did some further research and went with proton therapy in Jacksonville, FL at UFHPTI instead. So far, so good.

I had HDR. Brachytheapy in June of 2023 at Mayo Rochester For me the recovery was quick. I did feel fatigued for a day following each procedure but by the end of the week I was back to a light workout. I had mild issues with urine flow which improved with the meds within 30 days. PSA is dropping and feeling good.

Can you recommend a doctor at Mayo Rochester who does HDR? Are you still having no side effects?

I had two HDR brachytherapy sessions at Mayo Rochester a week apart in April 2023 (16 needles, then 17 needles). It was an outpatient procedure. Family drove me home both times. Wear loose clothing. Pack lots of things to drink and a pee bottle (I used a wide-mouth Minute Maid lemonade jar). I had a three-hour drive). It is generally a good idea to keep pushing liquids. There was no pain for me. I took a mile-long walk the next day. I didn't feel like hopping on a bike or sliding down a banister for a while but it is only that kind of pressure that make you realize you had something done. They do use a catheter but only during the procedure. One reason for the cath, besides the obvious, is to help them know where the urethra goes through the prostate. They put it in while you are under so no issue there. You are awake when it comes out because they do want to fill your bladder and have you pee before releasing you. No issues with that so don't worry about it. You are still feeling pretty happy and unconcerned at that point). From your point of view, you have a chat with the folks in the room, they say good night, then someone is trying to wake you up in recovery. Since they are burning out your prostate, there can be some swelling. You will be on a flow control drug to help. You will likely worry about getting blocked up and being unable to pee, but it is not likely to happen. The normal 21-second pee time for mammals will move to up to two minutes. But it does get better, though it can take about a year to get back to feeling normal. Ejaculate is a bloody mess for a while (similar to your biopsy but it can chunkier), but that goes away too. Since I only had one doctor for both procedures, I can't give opinions on that. He was great. Staff was great. You will be spoiled for any other medical facility. In the end, you will realize that you wasted time worrying about this procedure. Like the saying goes "worry is paying interest on a debt you may never owe."

Can you recommend a specific HDR doctor there?