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Brachytherapy planning and execution

Prostate Cancer | Last Active: Nov 18, 2022 | Replies (7)

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I have learned more about the planning process(es). One is pre-planned. One is do the planning on the day of the implanting. The third is sort of a real-time planning using imaging and maybe computer feedback--not sure about that. Based on my memory of that day I think maybe there was real-time planning and for that they might need 'x' number of seeds plus or minus based on imaging and actual seed implanting locations. So I am still learning and developing contacts.

I have ADT and the brachy. Now in planning stage for EBRT. My story is that I've had "executive check-ups" every two years or so for a couple of decades. Last year, at age 76, I had one and for some reason a PSA test was included. Came in 7.8. We had multiple situations going on and I didn't follow up with urologist. But, before some travel I had a second PSA (8.1) and then when in the States another (7.1). Upon return I did visit urologist, had biopsy. Then, not-funny comedy of errors, results were... not reported and when we did get them my doctor was in States for convention and the result was (5+4). I was no longer in the waiting mode and went to the capital city where I received the ADT and LD permanent brachytherapy. Now, proceeding with the EBRT more locally.

There has been another round of not-so-funny comedy of errors and we are waiting for a more complete report on the brachy so the EBRT planning can be completed. So, in one way, my question about brachy planning may get answered or may not be relevant except for my curiosity and need to be informed and to understand my treatment. Along the way I'm getting an unwanted education of sorts on mCi, Gy, Air Kerma Strength, 1-215 half-life and the conversion factor from 1microGym2/h to mCi. Probably becoming the Patient from Hell to terrorize the doctors. 🙂 But, feeling very positive, staying physically active and engaged with my projects and feeling thankful (almost guilty) about my situation compared to others I've seen and met at the cancer centers.

Appreciate your help.

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Replies to "I have learned more about the planning process(es). One is pre-planned. One is do the planning..."

I didn't really comment on "can only be answered by your radiation team". You're right about that and once they get the necessary info from the brachy team I will have another discussion with that EBRT team. Of course they do brachy at that center, too, and so they can shed a great deal of light, I hope. Since they are not involved in the previous steps they are more forthcoming. A bit of defensiveness by the urologist and the brachy cancer center. I may get replies here that the Gleason 5+4 is not consistent with the PSA scores (and prostate volume....). I know that. When I mentioned that, one doctor thought I was doubting the biopsy but I was just leading in to the point that my treatment was based on the Gleason whereas all the other metrics would indicate a grade 2-something and plus people would ask me about what stage or what grade and I was just trying to get to where I could place myself on these scales since people would be concerned and want to know. And regarding the number of seeds, they didn't understand my concern. They though I was complaining about having to pay for unused seeds. I knew full well that even if the whole process were cancelled for any reason that there would be no refund. My question was, and is, is having 38 or 42% extra seeds normal? Do they only come in packs of 20? That sort of thing. But I do think I have a good chance of getting answers from the EBRT team.

I had seed implants in 2005 at Sloan Kettering in NYC. Along with that had external beam radiation for 25 treatment. Now in 2018, the radiation has deteriorated what it touched in the bowel and bladder and both leak and need to come out. MRI at Mayo Clinic also show a part of the prostate is missing as in not all there as in part of it has dissolved with the old seeds just floating around. I had 81 seeds implanted. What they did has killed the cancer but now dealing with the radiation issues to those tissues and bad UTI's. Has this happened to anyone else?