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Brachytherapy: Regrets & Why ?
Prostate Cancer | Last Active: Oct 7 1:22pm | Replies (15)Comment receiving replies
Let's make sure we are talking about the same procedure ....
I am having HDR BRACHYTHERAPY.
On November 11, they are first doing the short term implantation of seeds.
From the perineum,
these are inserted and removed; not low dose or permanent. I'm told a template for 20 needles, also known as tubes, is used for location over the prostate.
A bit later following this and same morning, a CT/SIM ( simulation ) is completed.
Approximately 2 weeks later, I am to begin 6 weeks of daily external beam radiation.
My greatest concern is the long list of possible side effects, and damage to my rectum, just as one example, of my fears.
I can perhaps accept some chance of a poor outcome, but I can't accept "surprises later" just because I was too ignorant to ask and my doctor didn't bother to address my concerns as his.
I already feel that he does not welcome conversations of possible adverse outcomes.
Without proper disclosures, I could see myself NOT doing this.
Thanks !!
PAUL
Replies to "Let's make sure we are talking about the same procedure .... I am having HDR BRACHYTHERAPY...."
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Hi Paul
I didn't have the treatment you are having (HDR+EBRT), but I would have opted for this as well, except the specialist that did it was on long term sick leave.
For the EBRT, they can do prostate only (PORT), prostate + seminal vesicles or prostate + SV + pelvic lymph nodes. It depends on the stage and (PET) imaging. At stage T3B for example, it will include SV.
Side effects tend to increase with dose, so did they tell you what fractions (daily dose you will get or total dose?). Typically it is a dose for the HDR and a second dose for the EBRT measured in Gy.
If you want something technical this was one I researched at the time.
Ask chatgpt to summarize it for you! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8789612/
HDR is short range radiation and is supposed to limit exposure to organs at risk but the rectum is close and the EBRT will impact it as well.
Some centers use injected hydrogel spacers but mine did not, the papers I read on the subject gave some benefit but it was not dramatic.
I see you had colon cancer and surgery so are worried about that.
The thing about radiation is there are early and late effects. You can get some adverse effects during and a few months after treatment, these can return (or you can get new ones) some years later.
Mine were/are:
diarrhea during treatment (about 4 weeks into it and 2 weeks after) grade 2, easily treated with 1 immodium per day. Rectal mucous still get a little which tells me it is not OK but nothing else.
Mild (grade 1) burning pain on starting urination (and stronger/painful urge) this started towards the end of treatment and has not gone away 8 weeks later (which is a bit concerning).
If you get whole pelvic RT, it damages the bone marrow (I did not know this) and kills off the lymphocytes so you are more prone to infection for a few years until it recovers.
Radiation also can cause secondary tumours down the track so my RO tells me I will need colonscopies after a few years.
It's the late toxicity that worries me the most. I can live with stuff short term.
Good luck with the treatment.