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10 months after brachytherapy seeing a slight increase in PSA
I had brachytherapy in July of 2025 when my Gleason went for 6 to 7 (3+4) and PSA rose to 10. Since then I've been getting PSA checked every three months and in March of this year it had dropped to 0.331. My last PSA showed an increase to 0.407. Is this any cause for concern? I have an appointment with the urologist next week and he was upset that I did not originally do brachy, radiation and ADT even though three oncologists told me this would have been overkill.
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@climateguy That makes a lot of sense since seed therapy kills slowly over time; less time than in the past, but slower compared to SBRT.
Various forms of brachy make a lot of sense to me; less peripheral damage, very precise targeting.
And salvage therapy could include cryoablation or ultrasound - again, no peripheral damage.
I guess it’s all about the $$ and the lower rates of reimbursement.
But it should be lower, since it takes a little over an hour to complete and doesn’t involve huge complicated accelerators and the buildings to house them.
Phil
@heavyphil Mira Keyes, in a video “Brachytherapy: The Royal Flush of Radiation Treatment…” brought up an article published in Nature, Oct 31, 2019. It is in Nature online: https://www.nature.com/collections/gdafefdjba
She had a slide with a graphic from the article. The info on the graphic stated that in the US in 2019, Medicare paid $3100 per brachy treatment that cost the hospital $2700, whereas Medicare paid $9700 per IMRT treatment that cost the hospital $5500.
The net profit for brachy was $400, whereas the net for IMRT was $4200.
I think I misremembered what I was told and now recall they told me my PSA should drop to <1, not <0.1, after a year. So now I'm 10 months out and it has gone that low. I'm aware of the bounce also. BTW, Steven Kurtzman of Western Radiation did my procedure.
@climateguy $9700 PER ? You mean for ALL the treatments, right?
I don’t think my 25 visits to Sloan cost almost a quarter mill…
In any case, they are definitely undercompensated for brachy. Raise that number and the frequency would rise.
Phil
As I mentioned in another post, Steven Kurtzman of Western Radiation Oncology did my procedure. I'm aware of the possible bounce too. What they told me was no more biopsies or MRIs and that if PSA ever got back to 2 then they'd do another PSMAT. I've attached my PSA trend chart. Because it had been bouncing all over the place my urologist put me on finasteride to keep it steady. When on finasteride you need to double the PSA reading and that accounts for the anomaly of the quick drop from double digits.
PSA TRENDS (PSA-TRENDS.pages_.pdf)
@heavyphil Reimbursement for IMRT has been going down. BCBS paid $80K for 25 fractions in 2025 (all in); at Medicare rates that would have been about $30K. SBRT gets compensated at higher rates for the first 5 fractions (why almost no SBRT plan exceeds 5).
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1 Reaction@heavyphil There might be clarifying info in the Nature article. Compensation in Canada for it, according to Mira Keyes who works at the U of British Columbia is more reasonable, and the use of brachy is expanding there. My RO does brachy and external beam - he agreed if you do brachy in the US the financial incentive is not there.
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1 ReactionHere is my PSA and T post SBRT.
Me and my RO really like the bounce.
Stay Strong Brother, We Got This.
PSA and T Post SBRT (PSA-and-T-Post-SBRT.pdf)
@heavyphil The source for the cost comparison data Nature published was this paper: https://www.sciencedirect.com/science/article/abs/pii/S153847211830031X
"Process maps were created to represent each step of prostate radiotherapy treatment at our institution. Salary data, equipment purchase costs, and consumable costs were factored into the cost analysis. The capacity cost rate was determined for each resource and calculated for each treatment option from initial consultation to its completion. Treatment options included low-dose-rate brachytherapy (LDR-BT), combined high-dose-rate brachytherapy single fraction boost with 25-fraction intensity-modulated radiotherapy (HDR-BT-IMRT), moderately hypofractionated 28-fraction IMRT, conventionally fractionated 39-fraction IMRT, and conventionally fractionated (2 Gy/fraction) 23-fraction pelvis irradiation with 16-fraction prostate boost."
The Nature article compared the LDR-BT data with the "conventionally fractionated 39-fraction IMRT" data from the article.
So as I understand the article, the $9700 would have been the entire cost of the consults and 39 treatments vrs the consults and perhaps single treatment with LDR at this one institution. Another graphic in the Nature article was this:
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