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High Dose Brachytherapy after External Beam Radiation?

Posted 19 Feb 2019 at 11:42


Has anyone ever had high dose brachytherapy AFTER a course of external beam radiation?

Thank you.

Posted 19 Feb 2019 at 18:44
Normal curative EBRT takes the patient to the maximum amount of radiation that can be given to a specific area of the body. When men have brachy followed by EBRT, the dose for the EBRT is adjusted downwards. I can’t imagine it would normally be possible to have brachy after RT unless that possible treatment plan had already been factored into the EBRT programme.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

Posted 19 Feb 2019 at 19:31

Thank you, Lyn, since I posted the question we have found this out, you are spot on. 

Posted 20 Feb 2019 at 17:46
One exception to the rule! I had some as hoc Brachy on a met in my urethra a few years after my EBRT. It didn't work!


Posted 27 Mar 2019 at 23:56

Just found this thread, as it's what's being suggested for me.

PSA was 57, which has caused them to do lots of tests to find any spread, but they've eventually decided there isn't any although it is causing bulging of the prostate, so T3aN0M0, 3+4=7.

Have been on HT for a while, initially 6 months on 50mg bicalutamide during all the tests, but that turned out to be the wrong dose* and only brought PSA down to 47, so I'm now 5 weeks into 3-monthly Zoladex injections.

Plan is to have lower dose RT to whole pelvis (as a precaution), with a more concentrated RT dose to the prostate. This will then be followed by high dose brachytherapy afterwards.

They're sending me full details for the procedures (which I haven't got yet). There's no hurry - they've given me a month to think about it before next consultation, and it would be 2 months before any treatment starts anyway.

There is also a trial ongoing called PIVOTAL to assess the benefit of including whole pelvis RT which my consultant will put me forward for if I want (although my unusual HT might rule me out), but he is offering the full option of prostate and pelvis RT outside of the trial as he thinks it most suitable for my case, plus the brachytherapy. (PIVOTAL trial doesn't include the brachytherapy.)

So did you go ahead with this plan?


* 50mg bicalutamide is just to prevent harm from the testosterone flare (boost) you initially get when first starting Zoladex before it shuts down testosterone production, and not intended as a HT by itself - that would be the 150mg dose

Posted 21 Jan 2020 at 16:53

Hi. My husband has prostate cancer that has broken through the capsule. For treatment he started on Hormone treatment. He then started on 6 rounds of chemo. This was followed by 23 sessions of radiotherapy, lastly he had Brachytherapy. They have grown everything at him. His PSA is no undetectable from 50. It’s been a long and at times difficult journey but fingers crossed we are in a good place.

Posted 21 Jan 2020 at 17:30

Hi Mbull,

I did have the treatment I described above, more or less (EBRT followed by HDR brachytherapy, with ongoing HT). The EBRT was 46Gy prostate + seminal vesicles + pelvic lymph nodes (a pattern usually called prostate+nodes). Prostate is then boosted by an extra 15Gy HDR brachy, taking it up to 61Gy. No chemo - at the time I went through diagnosis and treatment, that was only added on curative path in the case of lymph node spread.

4 months after treatment, my PSA is undetectable (<0.01). However, see my thread for details - I suspect it would be same value at this time even if I hadn't had the radical treatments, so I'm not yet assuming this means I'm cured unless it stays low after I finish HT (although it won't stay that low).

My thread is here.


Edited by member 21 Jan 2020 at 17:31  | Reason: Not specified

Posted 21 Jan 2020 at 17:44

Hi, very pleased to hear of your husband’s progress.  My husband seems to be following a similar path, although his bone scan did show a lesion on the right hip, but they weren’t one hundred percent it’s spread of cancer as so isolated.  If you look on profile, Keith had his third chemo last Tuesday (has felt quite off this week) three more to go.  I am assuming he will then have RT to follow.

Best wishes to you both.


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