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Low dose brachytherapy long term side effect risk
My 55 year old husband has Gleason 7 (4+3) posterior peripheral T2a prostate carcinoma with PSA 5.2. 1 ml more or less volume tumour. PSMA pet scan did not show evidence of spread (we realize this can be false negative). We are trying to make decision on radical prostatectomy versus low dose brachytherapy as those are the two options most recommended for him. He is trying to chose and one big focus he has is on the long term side effects that will affect his general quality of life. Obviously if treatment not curative and further therapy with radiation, etc is needed then that is separate issue as we were told cure rates are similar for both RP and LD brachytherapy for his type/size of tumour.
Long term urinary risks present with both options however surgery more likely to be urine leakage issue whereas brachytherapy’s long term urinary risks appear to be more urgency, reduced stream/outflow, perhaps pain or bleeding from radiation induced cystitis. Rectal inflammation risk present long term with brachytherapy, not with surgery. Erectile dysfunction appears to be worse outcome with surgery than LD brachytherapy long term (I believe long term risk equal with external beam versus RP but less with LD brachytherapy, is that correct)? Very tough decision to make. He is reportedly a very good candidate for either surgery or LD brachytherapy. So comes down to this vague feeling choice based on perceived risks and if one of the lower chance long term side effects does occur, how manageable it will be. Just wondering if anyone has thoughts or more info on outcomes or how to make this choice. Are there statistics out there? Or are risks so individualized to age, tumour characteristics, general health etc that no further info out there to help. We seriously feel like we are in a coin flip situation . . . kind of scary . . .
The other info is that surgery can happen in 10 days whereas 2.5 month wait for brachytherapy locally then the tumour damage/control from it occurs over the following six months. That delay must increase risk of spread . . . not sure if the time delay significant for a Gleason 4+3 or we shouldn’t worry about that factor? Biopsies were back in beginning of September . . .
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I felt obligated to weigh in here even though those involved may already have sought their treatment--and I hope successfully-- since I had low-dose brachytherapy 18 months ago (at age 60), and I must give it equal time.
I didn't even consider surgery after looking into it, and after speaking with oncologists (more than one), my urologist and a surgeon. The possible longer term side effects just seem greater and outcomes for favorable intermediate (3+4) were the same. I didn't require ADT with radiation. Having few past urinary issues and being favorable intermediate, catching this early with a PSA of 5.75, made me a good candidate for LDR brachytherapy.
I was very lucky in that I didn't have even much that was noticeable in terms of short-term effects. The first few days following treatment I had the expected burning but it subsided. I had no urinary frequency in the early days and weeks (as most others seem to), possibly because I had no urinary issues before. I stopped taking flomax within weeks. Was sleeping through the night from early on, without getting up to urinate.
Had no gastro or rectal issues, no prostatitis, no problems with ED or sexual function. My PSA dropped dramatically at the 4 month mark and continues to remain low, now at 18 months out. Life has gone on, including sexual life, pretty much as it was before. I have spoken with many others who've had the same outcome. Sure, just as with every treatment, there are those who had more adverse effects. As has been stated, everyone is different.
Just please don't dismiss this one-and-done, minimally-invasive treatment which often has minimal effects if you are candidate for it.
havhav: did you get a second opinion from outside the institution you are using?
After 25 rounds of IMRT, I had LD Brachytherapy 9 weeks ago at age 67. The ADT (Eligard) side effects are almost gone but the pain is worse than it was the first 6 weeks after seeds. There have been 2 instances of sharp pain from my prostate/annal cavity where I had to take prescribed pain meds left over from the Brachytherapy procedure. It is hard to tell if this pain is prostate or anal cavity. Considering my stool is narrow, I am suspecting anal swelling. I have no idea what triggers the accute pain but it is worse now than when I first had my brachytherapy. I have been on Flomax 2 times/day and 5 weeks ago started meds for urgency (Solifenacin Succinate 10 MG ). I opted for homehealth services after Brachytherapy and 3 weeks ago the nurse took a urine sample which showed no infection but my Urologist put me on antiobiotics due to culture related results. As far as the pain goes, I havn't felt any better since completing the antibiotics. I guess my question to the group is for those who have had LD Brachytherapy and had painful urination and occasional accute pain, when did it start to getting better? I'm in my 9th week now since the procedure. I have had my 4 week follow ups with Oncologist and Urologist; at which time I started the extra dose of Flomax and Solifenacin Succinate for urgency to minimize getting up so much at night. It is my understanding that sometimes it takes 4-6 weeks for the Solifenacin Succinate to start working. After almost 6 weeks now, I really cant tell much of a difference in urgency and getting up at night. I'm hoping maybe there is someone on in this group that has had similar experiences that they wouldn't mind sharing. Thank You in Advance!