salvage HD brachytherapy

You had your EBRT a long time ago and it would seem that you still have some cancer which was either not completely eradicated at the time or has has grown since. It would seem that MSK feel that you could cope with the additional radiation that HD Brachytherapy would introduce. Sometimes Brachytherapy is given to augment EBRT as part of as treatment plan that is done consecutively but I can't recall having heard of it being used in the UK in the way it is being used a separate salvage treatment for you, although it may have been done in a small number of cases.

I had EBRT in 2008 and because a small tumour was found in my Prostate 2014, I had salvage HIFU in 2015. A very small tumor has been found again and I am due to have repeat HIFU. At no time was I offered HD Brachytherapy so I would be interested in learning why this is proposed in your case and if it is often used in this way where cancer persists in the Prostate notwithstanding previous EBRT.

Edited by member 19 Sep 2021 at 01:12  | Reason: spelling

If the cancer is believed contained in the prostate, you might be able to have a rectal spacer (such as SpaceOAR or Barrigel) to protect the rectum. However, previous radiotherapy might have resulted in too much fibrosis to enable a spacer to be inserted - the organ tends to end up stuck to those around it after RT, which is why a salvage prostatectomy is more difficult than prostatectomy as a primary treatment. On the plus side, your original treatment was probably not hypofractionated RT or proton beam, both of which lead to much worse fibrosis.

The HIFU I had in 2015 was to deal with a tumour in one side of my Prostate. Results are better if only one side is treated rather than the whole gland. (It has been reported that the top focal therapy expert in the UK no longer does full gland HIFU). Also, I had the HIFU within a study so I didn't have to pay for it. Furthermore, the philosophy of the team who undertake the procedure, is to treat only a significant tumour(s). It is argued that the Prostate is the last organ which is regularly surgically removed in it's entirety. Men should be carefully selected. HIFU can be repeated if a build up of calcium or fibroses is not a barrier. Patient selection is important so it is only suitable for a small number of men between those best suited to AS and those who need heavy radiation or Prostatectomy. So as well as being used as a primary treatment, HIFU may be used as a salvage treatment after RT to treat less severe tumours.. In the USA they tend to use Cryotherapy more and I wonder if this was considered as an alternative to the HD radiation? You also have the option of FLA in the USA.

At 85 I still have a long way to go to match my mother and father who lived to 101 and 98 respectively. I would much rather have another focal treatment and avoid the HT alternative I have been offered. I know from past experience that HT would make it more difficulty for me as a full time carer.

At a guess, I would say ST could be Sunday Times.