Experienced Permanent Seed Brachytherapy Doctors

Hi Andy, just go to Mayo - they’ll have the Doc you are looking for.

Thanks Phil. Problem is that my Mayo RO is the one dismissing this as an inferior approach and a dated protocol not worthy of consideration.

Specifically, in 2022 the research urologist I consulted said that he had inherited a practice with a lot of brachytherapy and had spent a lot of time dealing with the aftermath so he couldn't recommend that to me. As I now understand it, the reason is not because the seeds don't work, but because the cancer can be elusive.
I experienced a bit of this elusiveness in that I was originally believing I knew what I was facing from the mpMRI, but when that was redone on different equipment a second mpMRI found a second lesion, and that one, undetected the first time around, was actually the more advanced one, which changed my treatment options considerably. So far, though, I'm almost 3 years out with stable uPSA even though the post RALP pathology found positive margin and confirmed the intermediate unfavorable biopsy. So, while I didn't do the brachy, I do apparently have about a 75% chance of recurrence as best I can figure, and yet it still hasn't shown up, so what do I know?! God be with us all!

I guess then you are speaking about a seed-only approach? Yeah, no longer in vogue; it did have many successes but also more failures than other modalities.
But what they do now is temporary high energy seed placement for one hour - as a boost. The seeds are then removed and a few weeks later you have 5 SBRT treatments, sometimes with ADT. I met a few men at Sloan Kettering recently who were having this done.
One of the big problems they had with permanent seed placement was that some of them broke free and migrated to the lungs, where the radioactive seed caused cancer….I would stay away if I were you.

Thanks again heavyphil. I realize that permanent seed Brachytherapy has fallen out of favor. However, my research tells me that it has comparable cure rates and fewer side effects than other radiation protocols. Everything is dependent on the skill of the operator performing the procedure and unfortunately they seem to be few and far between. Dr. Steven Kurtzman’s practice in California performs hundreds of these year and over 7000 all time. He has a partner who is also proficient and indicates people can typically be scheduled for the outpatient procedure within 3 weeks of a consultation. Anyone who is interested in exploring permanent seed brachytherapy should take a look at this Youtube PCRI presentation by Kurtzman posted 1 year ago:

Truly, it seems like the best of all worlds: least invasive; one treatment visit; no surgery; fewer lasting side effects.
As I say, I encountered no one at Sloan in NYS having this - only high energy temp seeds + 5 SBRT’s.
Six years ago I met Dr Himanshu Nagar at Weil Cornell in NYC. His resume was almost complete permanent brachytherapy….but he said that once MRIdian SBRT came on the scene he pretty much stopped doing it. Don’t know if that’s still the case; he’s now at Sloan in NYC.
I do know, however, that over the years they’ve stopped using one isotope in favor of another. Don’t ask me which was which but I got the feeling that seeds migrating to the lung might have contained an isotope with a longer half-life, which is why they were still so radioactive and dangerous.
The newer seeds probably expend their energy in a relatively short time and IF they travel, do no harm. Best
Phil

Heavyphil. I truly admire your dedication to sharing in this community. Thank you on behalf of all of us brothers in arms!

You are most welcome! The guys on this board, many of whom have suffered with this disease way more than I have, have helped me more than they will ever know. Truly! It’s become my passion to share any tidbit of knowledge or experience - however insignificant or redundant - with others so they too
can benefit.
It’s a war, Wandy, and in war, brothers have each other’s backs!
Phil

I was "signed up" for HDR brachtherapy and on the table, all prepped and anesthetized. I woke up early to see a smiling physician who said...."well, we've got some good news and some not so good. Good news is that we're done, bad news is that we couldn't do the procedure". I had a loop of intestine that abutted the prostate which prevented proper placement of the catheters and thus precluded the insertion of the radiation. I am grateful to have had a diligent and observant crew that knew what they were doing that recognized a major problem and aborted the procedure before harm could be done. Thank you Dr. Johnson at Huntsman.

I was immediately scheduled for a consultation with the chair of radiation oncology. Wonderful guy. So, two weeks later it was another trip to Utah and LDR brachytherapy for me. Procedure went off without a hitch, at least for me anyway. I had a Palladium-103 implant. It's "middle of the road" as regards half life (17 days). The other two isotope choices are: Iodine-125 (t1/2 = 60 days) and Cesium-103 (t 1/2=10 days). Presently, Palladium and Iodine appear to be the most widely used.

So, four months after completing brachytherapy, and two months after completing twenty-five rounds of IMRT, I took a trip to the far reaches of the planet, that being southern Patagonia. It's a brutal trip, not from a medical/prostate/treatment/symptom standpoint, but because it's impossible to get comfortable in those danged airline seats on a ten hour flight. But I digress.

So, only two more tablets of Orgovyx and I'll have completed a six month course of therapy. About the only thing that I could do at this point would be to continue taking it for a bit longer. But, on balance, I wonder how much more I would benefit. Would the possibility of lowering the chances of a biochemical recurrence by a few points be justified by prolonging the side effects of ADR? Who knows? I'm going to pull the plug and hope like hell.

I have a blood test on monday so we'll see how the numbers immediate post treatment pan out.

All the best to everyone out there. When in doubt, go fishing. Big ones are guaranteed to put a smile on your face!