Looking for info on HDR Brachytherapy to ask Radiation Oncologist

Did your biopsy mention whether or not cribriform was found? If so the 5 sessions of proton therapy (SBRT) may not be sufficient and you might need to add HDR. Ask the RO.

IMRT is a lot more sessions and you only need the prostate radiated from what you say. SBRT is preferred by many.

This cheat-sheet was shown during one of the presentations at the 2022 ZERO Prostate Cancer Summit. It didn’t recommend brachytherapy for a 4+4, except as a boost with external radiation.

(For a 4+3, I had 28 fractions of proton radiation (during April-May 2021) + 6 months of Eligard.)

Sorry for delay, traveling with limited connectivity.
No cribriform, My RO says he won’t do SBRT, Thinks he can be curative with IMRT. Uses CT guided Linac. Claims Proton therapy has less movement planes and radiates the pelvic area more.

I’ve seen this chart but it seems that 4+4 treatments today include Proton in 5/25 fractions.
More importantly what were your results?

As you see in that 2022 chart, proton was a recommended treatment option for 4+4 as well.

However, in this 2023 Mid-Year PCRI presentation, Dr. Rossi (whose full proton presentation starts at 3:38:45) recommended against proton SBRT (starting at 4:30:45 during the Q&A session).

Now 4 years after my proton radiation treatments, my results have been great. PSA that was 7.976 immediately prior to treatments, now bounces between 0.35-0.55. My most recent PSA result (3 months ago) was 0.478; not bad for still having a prostate. Today, it’s as if nothing ever happened - just walked in a door, got treated (28x), and walked out the door…..it’s practically back to the way it was before the prostate cancer journey started.

Yes, Sloan does it in combo with external radiation - either SBRT or IMRT. You probably would need ADT as well.
Two guys were having this done at Sloan (with SBRT) while I was undergoing SRT there…
Phil

You need to get a 2nd opinion from a center of excellence RO or from a Genito Urinary Oncologist. Using IMRT was the industry standard when I had salvage radiation 12 years ago. SBRT is even used for that now.

SBRT is a pretty common technique to use, ask your RO if the reason he doesn’t want to use it is because he also wants to radiate the prostate bed, and suspects the cancer has gotten out of the prostate. That’s what it sounds like.

Another doctor may have a different opinion,

No, it’s not suspected of getting to the prostate bed. Clean PSMA, localized, just 2 cores. He says it’s because he can be curative with that. Got 2nd opinion from Mayo he He suggest proton therapy over Five fractions. Or a Trial of SBRT and machine learning radiation mapping. Being in AI for many years, I am skeptical. Sounds like a short course should be possible. Trying to figure out whether CT-guided proton therapy is good enough.

No cribriform. Localized to prostate. My main concern is urinary long-term problems. I guess he thinks smaller doses over a longer period of time reduces that possibility. Not to mention they make more money He did suggest HDR Brachytherapy was and option but they don’t do it there. It is also more invasive.

I have 4+4 and localized with clean PSMA. You are suggesting radiation is required so the margins are radiated? I have been on Orgovyx for several months now. My main concern is urinary or rectal problems.