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Brachytherapy? Anyone have thoughts?
Hi all. I have been on active surveillance for two years but psa is up to 6.49 so we did a second biopsy. Gleason 7 (3+4, 3+4, 3+3, 3+3). Just recieved Decipher score .29. I’m 65, still working and physically active. I know 2 men who did the low dose Brachytherapy with good success, but I don’t know what their numbers were. Any anecdotal experience with, or info about, that treatment path would be appreciated.
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@michaelcharles That has been my experience at Mayo Clinic - kind and genuinely concerned and caring.
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1 Reaction@thmssllvn
I agree it makes sense to do HDR Brachytherapy first, followed later with external beam radiation (2 weeks later with 5 sessions SBRT). That was my treatment plan with Dr. Chang at UCLA.
18 months later, according to my RO there's "no evidence of disease".
(Prior to treatment, PSMA PET scan showed my stage 2 Gleason 9 cancer was confined to the prostate.)
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1 ReactionI’m not sure why both would be necessary given your Gleason score? Unless it has spread beyond the prostate. The point of HDR is to get the cancer damaging as little collateral tissue as possible. Why then apply external beam which doesn’t have that characteristics unless it has spread. If it has spread, then the external beam may make sense.
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1 Reaction@robertov, in my case (stage 2 G9), even though PSMA PET scan showed no spread, adjunct external beam radiation was highly recommended for my treatment plan.
That recommendation was the same whether I opted for surgery or HDR Brachytherapy.
Before deciding, I consulted a surgeon (prostate specialist). In addition to RALP, he also recommended adjunct external beam as part of my treatment.
I think it's a risk vs reward decision.
At my age (72), I believe the long-term risks of adjunct radiation are outweighed by the benefit of a potential "cure". At the very least, for my aggressive prostate cancer, I believe adjunct radiation substantially delays a likely biochemical recurrence.
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1 ReactionI had BRACHYTHERAPY two weeks ago. 4+3+7 Gleason and a PSA of 6.4. SMA PET found all Cancer confined to the prostate. Urinary side effects were tough for about 5 days then dissipated - burning, frequency, etc.. I'm also on ADT Orgovyx for six months.
Started eternal beam radiation (25 sessions) today. Feel good but, a bit tired. One day at a time.
@retiredboomer71 You make a solid point. My Gleason is 8 so high-risk but not as high as yours. I’m 74 so close to your age. It was a difficult decision but my RO view was to treat what he could see. That was my philosophy in general, so I was comfortable with that. It is a risk/reward decision. I think yours was a solid choice.
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1 ReactionOK, I'm 75, gleason 9 with no spread on PSMA. I elected HD brachy, 6 mo ADT, and beam radiation because during my joint consult with a surgeon and radiation oncologist they said I be a poor surgical candidate
Look here. You will see brachy is very curative. This is because since the radiation comes from inside thebprostate, it doesn’t pass through any organs, they can dose you up a bit higher…
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Here is a good website to compare odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see the odds of 10-20 yr survival, etc. based on the treatment you pick.
https://www.prostatecancerfree.org/compare-prostate-cancer-treatments/
It is best viewed on computer or just print it on paper. Not so viewable on phone.
To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.
Also be aware the the graphs don’t show any salvage radiation benefit. This would boost the surgery odds up a bit.
And, this is a very dysfunctional industry from my view. Loads of bad info mixed in with the good info. Same with the docs. Many of them are more dangerous than the cancer.
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4 ReactionsHi guys! All the info has given me some peace although my brain works overtime. I started Lupron (2 weeks almost waiting for the dreaded side effects - hope doesn’t do to bad on ne) Did 30 days bicamultide and oncologist recommends brachy +VMAT I’m really not sure if I want to stay on Lupron sone people say oncologists don’t recommend it when doing brachy? I’m gonna find out more from my oncologist .. don’t start until Jan 9 2026 .
Thoughts ?
@groundhogy don’t know how I missed it just saw your post after I posted the question thanks by what I read what you say is good.. I’ll look into this ..