Anyone have HDR Brachytherapy and Proton beam therapy combo?

IMRT followed by HDR Brachytherapy is somewhat common. It makes sense they would try it for SBRT as well. SBRT is not supposed to work too great with cribriform. Including HDR brachytherapy, After SBRT, would make a lot of sense to try.

Must admit this is not something I have heard about in this forum. Some people have discussed doing salvage SBRT but there were some real issues.

@jeffmarc
Thanks for the reply Jeff. Just to be clear adding HDR Brachytherapy with SBRT or Proton would be good if someone has cribriform? RO also mentioned HT like Lupron could be added for up to 18 months.

@copyman
They use IMRT followed by HDR brachytherapy now, it gives people a lot more confidence that they will not have it come back. SBRT also isn’t always effective all by itself. The HDR brachytherapy would add another level of protection against reoccurrence.

I think this would be usable for more than people with cribriform.

Yes, there are a number of clinical trials looking into this. Here’s one: https://www.cancer.gov/research/participate/clinical-trials-search/v

I'm not expert on the difference between proton and photon RT. The thing is, they are both external beam radiation therapies.

Some highly respected authorities argue that proton, for prostate cancer, isn't better than photon. Proton advocates claim its better. Recent studies have not found one to be superior to the other. Eg.: https://www.astro.org/news-and-publications/news-and-media-center/news-releases/2024/astro24efstathiou

The main idea, and the reason your RO is suggesting a form of external beam (EBRT), i.e. proton, combined with a form of internal RT, i.e. HDR Brachytherapy, is that no external beam, either proton or photon, can deliver as high a dose to the prostate as the combined EBRT plus HDR BT boost therapy.

And if you are looking for better long term success and less time on ADT, you should consider the EBRT plus HDR boost.

Dr. Nelson Stone gave a good lecture on why this is, at the 2024 Prostate Cancer Symposium https://www.youtube.com/watch

The American Brachytherapy Society commissioned a comprehensive literature review that was published late 2025, entitled - "High-dose-rate (HDR) brachytherapy boost in combination with external beam radiotherapy for localized prostate cancer: An evidence-based consensus statement" https://pubmed.ncbi.nlm.nih.gov/40707306/

This paper concluded: "For men with intermediate- and high-risk prostate cancer, HDR brachytherapy boost is a safe and effective technique for dose-escalation that can achieve superior biochemical control compared with EBRT alone, possibly with an improved GU and GI side effect profile compared with an LDR brachytherapy technique"

I was PSA 7.1 with Gleeson 3+4 snd 4+3 and had 5 weeks IMRT followed by one high dose brachytherapy “boost” procedure as my Rao termed it. I also had six months of Orgovyx ADT pills.

Neither the IMRT or the HDR procedure were a big deal save for the five weeks of daily treatments.

Now 11 months post treatment I am happy to report my PSA is .1 snd I have zero side effects

You should inquire with your clinicians about IMRT vs SBRT. I agree with Jeff that this the idea of HDR with SBRT is a new concept for me

Best of luck to you

@capatov
Is your PSA .1 or is it less than .1 (< .1). Since you’ve had radiation, it doesn’t matter all that much, just wondered.

That really is a good combination of treatment, I suspect it will give you many years of remission.

@jeffmarc initially after my radiation treatment my OSA was 0.04 but it was artificially low due to tail end of six month Orgovyx regime. Now 10 months later I am at .1.

Thanks for the words of encouragement

@jeffmarc When @copyman mentioned 5 sessions of proton that has to mean proton radiation administered in an SBRT format, right? That's the only way that you could get so few sessions. But if the trial is more concerned about comparing just proton to photon radiation, I suppose they could apply proton radiation in the same low dose way as photon IMRT radiation is applied in 25 sessions. That wouldn't be much of a trial as that would guaranteed work. But maybe the trial is intentionally wanting to test gentle proton radiation in a 5 session high dose SBRT format in order to see if that approach reduces the risk of toxicity when SBRT is applied in this way?

@capatov I too was wondering about the .1 PSA number you gave. You do get two decimal place accuracy on your PSA values, right? Which means your PSA was precisely 0.10. I had similar treatment as you. One year after a year of ADT, 26 IMRT treatments and one HDR brachy treatment my PSA is 0.13.