High Dose Brachytherapy after External Beam Radiation?

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

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

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