Brachytherapy , but they came across a Stricture and cancelled

Posted by chamblee54 @chamblee54, Feb 29 11:44am

Nov 1 /23 I was scheduled for Brachy. After being out under , and while inserting catheter they discovered a stricture and Beachy was cancelled. Got stricture repaired 2/12/24. Go back to Dr and he doesn’t want to do Brachy anymore for risk of developing new stricture.
He wants to do 44 IMRT and Hormone.
My PSA last year was 6.7, now two weeks ago 3.6 (what it was 2 years ago.)
Biopsy showed 3/12 + cancer. 2 were 3+4, and 1 they lost and found 5 weeks later that was 4+3.
I’m wanting to avoid Hormone due to quality of life issues. I wanted Brachy for the one and done. Won’t IMRT have similar risks of stricture ? So confused. Need feedback. One patient advocate group suggested that the 44 + hormone is way more profitable than Brachy and not significant difference in outcome- . Brachy is limited payout by Medicare. Who do I believe !? Big decision. Is profit motivating the treatment recommendation ?

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

chamblee, Medicare is good about second opinions. I'd say get third and fourth. I harbor suspicions about recommendations sometimes based on profit, but never speculate. I don't think two opinions are enough to base a decision on. Best wishes.


chamblee54: Dr's are human and though dedicated, they do have their bias', financial management, machines treatment processes they have had success with without regard to other options and so on.

I agree with gently regarding multiple opinions. I had 5 radiation oncologists' opinions and Medicare paid for them all. I settled on 5 hypo fractional treatments with a narrow margin Mri linac machine with narrow 2 mm margins (vs 3-5 mm for other forms of radiation). Protecting my healthy tissue to avoid side effects was a key in my choice. I finished treatment last February.

I did not have strictures, though after 3 hits of radiation I did need Flomax which worked overnight. All good now. Still slightly restricted in my urine flow but the dr had told me to expect the flow to be about the same as it was pre-treatment.

You might want to consider a decipher test using your biopsy material to give you an idea on modes of treatment and aggressiveness (hormone treatment is considered a mode of treatment). Also, I used Spaceoar to separate the rectum from the prostate. BioProtect and Biogel are a couple of other choices.

I did not find much data on brachytherapy for prostate cancer, in the long term, though I had a friend who used it for Thyroid cancer. Absolutely talk to more doctors at centers of excellence. Send them your imaging and set up a consult.


@chamblee54 My Gleason scores were similar to yours. I also saw multiple ROs and Urologists. Eventually, I was dissuaded from HDR Brachytherapy that caused significant damage to some patients at my institution. My 'boost' radiation was Cyberknife which, according to a published study, was equally effective with fewer side effects. Depending on the amount of time and interest that you have, you can read, on this site, about a plethora of alternative radiation technologies, all with certain advantages and disadvantages.

My tri-modal treatments completed 1/23 (Cyberknife x2; EBRT x25; ADT 4 months). I am 90% recovered and only bothered by slightly reduced urine flow. I still take one Floxmax per day, no other drugs.

The Orgovyx form of ADT for 4 months was not challenging for me. Some hot flashes that, as winter approached, were occasionally welcome. If you consider Orgovyx, be sure to check the costs. They have various methods for financial assistance that many folks are able to qualify for, otherwise the drug is expensive.

As mentioned, getting the Decipher Grid done is great since they use existing biopsy samples and it's covered under Medicare.

Best of luck!!


@chamblee54, I'm wondering how you are doing in your decision making. Have you decided to get a second opinion?


@chamblee54, I'm wondering how you are doing in your decision making. Have you decided to get a second opinion?

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I reached out to MD Anderson today for a Consult.

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