1. < Prostate Cancer

Looking for info on HDR Brachytherapy to ask Radiation Oncologist

Posted by robertov @robertov, May 24 1:37pm

I’m trying to decide on IMRT, Proton Therapy 5 fractions, or HDR for localized Gleason 4+4 PC. PSMA came back clean. I keep wavering. Looking for a good HDR site and discussion with RO about it.

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heavyphil | @heavyphil | May 26 7:47am
In reply to @robertov "I have 4+4 and localized with clean PSMA. You are suggesting radiation is required so the..." + (show)
@robertov

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.

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Well, HDR brachy is a one shot deal - seeds in and out in 45 -60 mins to blast the G4+4. It is then followed by either IMRT or SBRT to treat the remainder of the gland/bed.
It is possible - and please get clarification on this - that your RO wants to treat your pelvic nodes as well and that’s why he wants to use IMRT.
Not sure if SBRT is suitable for that? But if you only have the one small area of G4, no cribriform and a low (?) Decipher I can’t see why 5 fractions wouldn’t be preferable. Best,
Phil

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2 replies
robertov | @robertov | May 26 8:07am
In reply to @heavyphil "Well, HDR brachy is a one shot deal - seeds in and out in 45 -60..." + (show)
@heavyphil

Well, HDR brachy is a one shot deal - seeds in and out in 45 -60 mins to blast the G4+4. It is then followed by either IMRT or SBRT to treat the remainder of the gland/bed.
It is possible - and please get clarification on this - that your RO wants to treat your pelvic nodes as well and that’s why he wants to use IMRT.
Not sure if SBRT is suitable for that? But if you only have the one small area of G4, no cribriform and a low (?) Decipher I can’t see why 5 fractions wouldn’t be preferable. Best,
Phil

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No Decipher score as no cells taken during the biopsy. Urologist never mentioned it. I understand? that SBRT is suitable, but my RO thinks he can ‘cure’ me with IMRT.
My thinking now is that maybe it has less side effects than SBRT, which is, of course, my main concern now. I was also offered CT-guided Proton Therapy in 5 fractions. The IMRT RO thinks it is more gimmicky and the degree of rotation not as good as in IMRT. Struggling with those choices.

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1 reply
robertov | @robertov | May 26 8:11am
In reply to @jeffmarc "Did your biopsy mention whether or not cribriform was found? If so the 5 sessions of..." + (show)
@jeffmarc

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.

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No cribriform. Everything looks clean only 2 cores. The Proton technology, according to an RO suggesting CT guided IMRT thinks it doesn’t have the degrees of freedom in getting to the cancer. I’m also worried about higher risk of side effects with 5 fractions vs IMRT.

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heavyphil | @heavyphil | May 26 8:50am
In reply to @robertov "No Decipher score as no cells taken during the biopsy. Urologist never mentioned it. I understand?..." + (show)
@robertov

No Decipher score as no cells taken during the biopsy. Urologist never mentioned it. I understand? that SBRT is suitable, but my RO thinks he can ‘cure’ me with IMRT.
My thinking now is that maybe it has less side effects than SBRT, which is, of course, my main concern now. I was also offered CT-guided Proton Therapy in 5 fractions. The IMRT RO thinks it is more gimmicky and the degree of rotation not as good as in IMRT. Struggling with those choices.

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A bit confused by ‘no cells taken during biopsy’ - isn’t that what a biopsy is? Pretty sure they can do genetic testing of some kind even on biopsy samples already taken, but check on that…
Radiation is weird and side effects really do vary. As a blanket statement, SBRT will cause more SE’s but they should resolve within a short time; but some men have zero SE’s…
As for the proton/photon comparison, perhaps someone on the board who has had treatment can answer that question. Sounds bogus to me - especially with the high degree of technology we have today - but I just don’t know. Best,
Phil

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1 reply
jeff Marchi | @jeffmarc | May 26 11:00am
In reply to @robertov "No cribriform. Localized to prostate. My main concern is urinary long-term problems. I guess he thinks..." + (show)
@robertov

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.

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Unfortunately, there is no way to know if you will have urinary problems after treatment. After radiation, minor issues are come up, but after surgery, some people never get continence. There is no way of knowing what your results will be. It is not unusual for people that have had radiation to have urinary incontinence issues years later, that’s what happened to me six years after radiation.

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2 replies
robertov | @robertov | May 26 4:54pm
In reply to @heavyphil "A bit confused by ‘no cells taken during biopsy’ - isn’t that what a biopsy is?..." + (show)
@heavyphil

A bit confused by ‘no cells taken during biopsy’ - isn’t that what a biopsy is? Pretty sure they can do genetic testing of some kind even on biopsy samples already taken, but check on that…
Radiation is weird and side effects really do vary. As a blanket statement, SBRT will cause more SE’s but they should resolve within a short time; but some men have zero SE’s…
As for the proton/photon comparison, perhaps someone on the board who has had treatment can answer that question. Sounds bogus to me - especially with the high degree of technology we have today - but I just don’t know. Best,
Phil

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Thanks Phil. What i meant was no cells were removed to send for a decipher test. I assume you need the actual cells? I just assumed all that was left were pictures. I think you are suggesting the ‘slides’ can still be used for a decipher test?

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1 reply
robertov | @robertov | May 26 4:58pm
In reply to @jeffmarc "Unfortunately, there is no way to know if you will have urinary problems after treatment. After..." + (show)
@jeffmarc

Unfortunately, there is no way to know if you will have urinary problems after treatment. After radiation, minor issues are come up, but after surgery, some people never get continence. There is no way of knowing what your results will be. It is not unusual for people that have had radiation to have urinary incontinence issues years later, that’s what happened to me six years after radiation.

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Thanks Jeff. I was wondering If there were any differences between 5 fractions vs 45 fractions. I’ve read the studies showing no diffs. Not sure whether i trust them.

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1 reply
robertov | @robertov | May 26 5:01pm
In reply to @jeffmarc "Unfortunately, there is no way to know if you will have urinary problems after treatment. After..." + (show)
@jeffmarc

Unfortunately, there is no way to know if you will have urinary problems after treatment. After radiation, minor issues are come up, but after surgery, some people never get continence. There is no way of knowing what your results will be. It is not unusual for people that have had radiation to have urinary incontinence issues years later, that’s what happened to me six years after radiation.

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That is so weird that 5 years later it would occur. What is your understanding of why that happens.

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1 reply
robertov | @robertov | May 26 5:11pm
In reply to @heavyphil "Well, HDR brachy is a one shot deal - seeds in and out in 45 -60..." + (show)
@heavyphil

Well, HDR brachy is a one shot deal - seeds in and out in 45 -60 mins to blast the G4+4. It is then followed by either IMRT or SBRT to treat the remainder of the gland/bed.
It is possible - and please get clarification on this - that your RO wants to treat your pelvic nodes as well and that’s why he wants to use IMRT.
Not sure if SBRT is suitable for that? But if you only have the one small area of G4, no cribriform and a low (?) Decipher I can’t see why 5 fractions wouldn’t be preferable. Best,
Phil

Jump to this post

You are exactly right. My RO wants to treat the pelvic nodes. You bring up a distinction that i have missed: whether SBRT or Proton therapy can do the pelvic nodes. Now I’m not sure.

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1 reply
robertov | @robertov | May 26 6:50pm
In reply to @jeffmarc "You need to get a 2nd opinion from a center of excellence RO or from a..." + (show)
@jeffmarc

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,

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Hi Jeff, Got a 2nd opinion from a CofE. They suggested Proton Beam, 5 fractions (SBRT). The RO for IMRT just thinks that he can ‘cure’ and won’t do SBRT. Don’t know exactly why he is adamant about it. He hasn’t said anything about the prostate bed. Claims their equipment is more modern that the equipment at the CofE Both are smart and seem capable. I’m more concerned about urinary and rectal problems. The latter is probably not likely.
As for ED, I’m 73 with an older wife. At my age I’m invisible to younger women and no threat to younger men 🙂

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