Low dose brachytherapy long term side effect risk

One doctor who is very experienced in LDR-B (low dose brachytherapy) uses a pre-procedure plan of seed placement. He had commented that APEX positioned lesions can be problematic. He did not comment on the size of the lesion or other possibly important issues beyond the position at the bottom (Apex).
Another group in the west use an intraprocedural rectal ultrasound imaging, MSKC (Memorial Sloan Kettering...) in NYC uses CT guidance for seed implants. MD Anderson [MDA (formerly MD Anderson Cancer Hospital)] uses MRI.

@majortee I don’t think I’ve come across your particular combination: IMRT with LDR brachytherapy; it’s usually HDR.
Can you tell us what the reasons were for this type of treatment? Thanks,
Phil

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!

havhav: did you get a second opinion from outside the institution you are using?

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.

@hymana, side effects of brachytherapy are often temporary. Brachytherapy for prostate cancer can cause some long term side effects such as passing urine more often and difficulty getting an erection. Everyone is different and the side effects vary from person to person. You may not have all of the effects mentioned.

So as I understand it these brachytherapy side effects may not go away? That’s a shocker. I was under the impression they were only temporary. Almost 7 weeks now. I’d guess I’m 60% of normal before surgery. Has anyone ever gone this long and eventually have the pain, frequency and difficulty go away? And if not is there any follow up - BTW I’m 74.

@hymana, I can imagine continued side effects after brachytherapy are concerning you. You're asking good questions. To help you connect with other men who have had similar experiences, I moved your post to this existing discussion:
- Low dose brachytherapy long term side effect risk: https://connect.mayoclinic.org/discussion/low-dose-brachytherapy-long-term-side-effect-risk/

@hodagwi @kcinthetropics @bens1 @havhav @web265 may have some thoughts to share about their experiences with brachytherapy side effects and how to manage urination and pain.

I had Brachytherapy 46 days ago. I was told the side effects would last no more than a couple weeks. I am still experiencing painful, frequent and difficult urination. I just saw the doctor and he said that this is very abnormal but just wants me to wait it out. Will i eventually get better or what can be done if i dont. I’ve had two rounds of steroids, quit drinking alcohol or coffee at the doctors recommendation. Right now i am miserable. My urge to go starts with pain in my scrotum and then waiting 45 -120 second to start urinating follow by pain in the penis and a difficult flow of 250-300 cc’s. What should i do?

Thank you - the comment about making a choice being almost incapacitating sure hits home. We have been debating side effects, especially long term side effects, non-stop. We would love it if our RP outcome was as good as yours has been (!) but feels like it’s a bit Russian roulette whether any erectile function can return after RP surgery. Best odds I’ve seen is 50:50, worst more like 70% don’t return to functional level. Urinary function - thanks for the tip on membranous urethra length - we didn’t get that with the MRI report but will ask the surgeon. At this point, unless something else changes or maybe that membranous urethra length number is super low, we are planning for surgery. My husband is very averse to any risk of rectal complications as he has already had some issue with hemorrhoids (now treated) and really doesn’t want to risk any of the longer term recurrence of rectal issues years down the road after brachytherapy, even though those numbers are quite low. Also, between risking urgency issues and getting up multiple times a night to pee and urinating frequently throughout the day, etc that can be risk of brachytherapy long term, he would like to avoid that. We realize surgery might lead to long term urinary incontinence but hopefully that is less likely as he is younger than average, etc. But still, he figures he can manage long term leakage with better quality of life than frequent urgency issues 24 hrs a day. The erectile function side effect of surgery is way worse than brachytherapy though 🙁 Which he is very depressed about. He feels there is a gun to his head because of the cancer and he has to pick a treatment as his stage T2a and Gleason score (7 - 4+3) with a bulging prostate capsule where the mass is doesn’t leave him much choice. But so hard to risk losing all erectile function when that is something he has never had even the slightest hint of any issues with, let alone the changes to orgasm experiences, etc that will occur. We are quite sexually active so this will be a major game changer for him 😔. Cancer really doesn’t leave a lot of room for wishful thinking though - the primary thing is to do our best to get rid of it or kill it off right from the start. At least that’s the stage we are at now. If recurrence occurs or surgical margins are positive then we deal with that one step at a time when it happens.