HDR Brachytherapy as monotherapy treatment experiences

I had one HDR procedure as a "boost" to 25 daily IMRT sessions and six months Orovyx ADT. Overall virtually no long term side effects (pain, bleeding, incontinence, impotence, etc.). Just hit nine months post treatment mark and PSA down from 7 to .1. I am a big believer in HDR but I don't know the efficacy of using it as a monothereapy...my HDR was a boost on top of other treatments

@capatov

Thank you for sharing your experiences.

I had 2 sessions of HDR Brachytherapy as a mono therapy 3 years ago at Mayo Rochester. I had no significant side effects following the procedure and doing well.

@marshallfeller So TWO hour or so treatments and done? No IMRT/SBRT? That is really impressive.
Seems to me that would be the way to go…any contra-indications for this - ie. Location, size, etc?
Phil

When I had a consult with RO, said radiation would make my BPH worse and that included HDR Brachyboost +SBRT. Ended up recommending ADT to shrink prostate for 6 months and then plant some marker seeds, some rectum gel the 28 treatments of IRMT or 5 of SBRT. Then increase Flomax to 2 times a day and add Cilais. Then a long list of side effects that I didn't like.

Sounds like a good plan and glad it worked for you, but they didn't think good for me because of the years of BPH I have had.

@heavyphil
At the Rochester Mayo I had the option of HDR monotherapy or proton which would have been 5 treatments over a 2 weeks. There are not of many RO trained in this procedure and I am assuming it is very expensive to set up the equipment and staff it. The treatments are set up 2 weeks apart and they need to put you under. Most people do not want to be put under and choose the proton. For me I chose the HDR Brachytherapy to reduce the travel.

@heavyphil

I have not made a decision on when and how to treat. Initial biospy last year was gleason 3+3, but with a 2cm pirads5 lesion.

The radiation oncologist has recommended HDR brachytherapy (2 sessions), if I choose radiation. She feels this is a very good option for myself. She said they did not use spacer gels (at this time). Their studies/experience indicated the spacer gels with HDR were either not helpful or worst case, interfering with the radiation.

The RO has been very diligent in looking at my information and not just checking “boxes” during appointments. Decipher score came in about 3 weeks after initial consult (based on MRI and biopsy).

She reviewed Decipher score of 0.48 and had me come in for another consult. We discussed continued active surviellence, but the need to be watchful with a pirads5 lesion and mid-range decipher. She then arranged for a PSMA petscan. After petscan did not show any activity outside of prostate, she indicated:

Two sessions of HDR was still her recommended radiation treatment.

If I was approaching 70 years of age (just turned 61), HDR would be the most attractive treatment. This is from my current studies/knowledge.

Best wishes.

I opted for high-dose brachytherapy (HDR), two sessions a week apart (at age 70). No other forms of treatment. Mine was two out-patient treatments a week apart. Although the procedure sounds pretty nasty, you are knocked out for it all. I had no pain with the procedure (some "tenderness" for an hour and half). I left the hospital (Mayo Rochester), picked up some chicken and lottery tickets and was driven home (3.5 hrs) by family members where I took a 1.3-mile walk. My cancer likely started in my early 60's (10 years before HDR). My PSA was at 5.48 in 2017. A biopsy was recommended but then a health care dispute in my city caused a loss of nearly all urologists (many quit, others fired, and leaving the city without urologists due to noncompete clauses). So, I did nothing. In Dec 2021 PSA at 7.8 sent me to an MRI, with 4 lesions at PI-RADS 5, 4, 3, 3; biopsy May 2022, finding cancer found in 13 of 18 cores, two with PNI, most at 3+4. I had surgery or radiation options. An Aug 2022 Decipher test was 0.42 (high end of low risk). I decided to wait and see. Dec 2022, PSA at 10.7. A second MRI Mar 2023 showed substantial growth of a lesion pushing on the capsule. I had HDR brachy in April 2023. I pushed fluids and still do. I was on Flomax and a short stint of Ibuprofen for inflammation. Slight pink and small soft clumps in pee for a couple weeks. That cleared up at 20 days. Ejaculate still red. Quit Flomax at 50 days. Ejaculate clear by 75 days, but all ejaculate eventually goes aways (two years out). Flow does not "seem" as strong as before the procedure but nothing to complain about. Mammals average void is 21 seconds, I can vary from 30-90 seconds. Nothing like when I was 16 but not far from where I was at 60 (73 now). None of the bad results from surgery (ED, incontinence, etc.). It takes years for your PSA to go down. I went from a high of 10.7 before HDR, to 3.6 after HDR, to 1.42 almost 2.5 years later. It will bounce a bit on the way down. They key in any medical procedure is to pick a good place to have the work done.