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salvage HD brachytherapy

User
Posted 18 Sep 2021 at 15:15

Hi guys,

I have a localized recurrence after being treated with EBRT in 2004-05.

My gleason currently is 4+3 and PSA 1.6

In NYC, the top hospital Memorial Sloan Kettering wants me to do Salvage HD brachytherapy. I am concerned about toxicities…  

Would appreciate any feedback…

User
Posted 19 Sep 2021 at 01:11

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

Barry
User
Posted 19 Sep 2021 at 15:28

Hi,

 Salvage HD brachytherapy isn’t done in UK, i am not sure…However, there are many articles and studies explaining that it is a reliable option after EBRT. It has possible toxicities (SEs) associated with it. This is the main reason why i am questioning having it.  

    Possibly they feel it is the best option due to the fact that the cancer is aggressive. Additionally, they are telling me that there is a 70/60 % “cure” rate depending if i have or don’t have ADT beforehand…(There is a Decipher test that determines the aggressiveness). There treatment plan at MSK takes this into consideration as well as the fact that there is intraductal carcinoma “present”…However, i believe that they are primarily focused on the aggressiveness of the rumor.

In that you have another tumor, did they first do whole gland HIFU? In other words, did the current tumor come back at the same location? We’re there any side effects…

If i do this treatment i am asking that they do focal brachytherapy since the tumor is only on one side of the prostate. 

Having already had EBRT, i also question having more radiation in the form of brachytherapy. I know what you are saying about first having both EBRT and a form brachytherapy which may have been better to have had. This is High Dose, no seeds…Put the dose in for 15-20 minutes and withdraw it. 

In any case, the doctor doing it is “tops” at Memorial Sloan Kettering in NYC. But as i say, the toxicities of incontinence, leakage, urethral strictures, rectal damage are all possibilities. 

Did you have to pay for the HIFU…i am not sure about your age: however, i did see that you are 85. If so, I am wondering why you feel a need to have more treatment…The docs that i speak with always mention having or not having treatment depending on age!

 

Bill

 

User
Posted 19 Sep 2021 at 22:30

Originally Posted by: Online Community Member
In any case, the doctor doing it is “tops” at Memorial Sloan Kettering in NYC. But as i say, the toxicities of incontinence, leakage, urethral strictures, rectal damage are all possibilities.

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.

User
Posted 19 Sep 2021 at 23:14

Andy,

   Originally had 8 weeks of EBRT…only side effect was a bit of fatigue. 

Now 16 years later it’s a localized recurrence. Their plan is doing HD BT twice with a two week break…I am checking with MSK about the “scarring” which the top doctor briefly mentioned in our last Zoom conference. He did say that there wouldn’t be a problem placing the tubes to deliver the dose. I need more clarification.

I also feel that having 11.5 gy is high in that i already had radiation! That dose would be given twice, two weeks apart!

They would be using Spaceoar to protect the rectum. However, there are still acute and late toxicities involved. I only hear percentages…! 

I know of guys having brachytherapy as their first treatment but haven’t heard about “salvage” HD BT after EBRT… Are you familiar with this salvage treatment being used on anyone?

Bill

 

User
Posted 20 Sep 2021 at 00:12
Was reading in the ST earlier that two 11.5gy doses was being trialled as the new RT treatment. It is thought that it might be as effective as the normal lower dose/higher instance treatment but have less side effects.
User
Posted 20 Sep 2021 at 00:32

Thanks…is that also the dose for “salvage” HD BT…i had EBRT 15 yrs ago…

BTW, What is the ST? Possibly something in the UK!

User
Posted 20 Sep 2021 at 04:25
Hi Bill,

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.

Barry
User
Posted 20 Sep 2021 at 07:43
Yes, Sunday Times. It didn't mention salvage treatment, unfortunately, but logically what's true for initial would also be true for salvage. Whether it's too much radiation overall is another matter - I would certainly question them hard on that on.
User
Posted 20 Sep 2021 at 08:01

Originally Posted by: Online Community Member

Andy,

   Originally had 8 weeks of EBRT…only side effect was a bit of fatigue. 

Now 16 years later it’s a localized recurrence. Their plan is doing HD BT twice with a two week break…I am checking with MSK about the “scarring” which the top doctor briefly mentioned in our last Zoom conference. He did say that there wouldn’t be a problem placing the tubes to deliver the dose. I need more clarification.

I don't think fibrosis would hinder the brachy catheter placement.

Originally Posted by: Online Community Member
I also feel that having 11.5 gy is high in that i already had radiation! That dose would be given twice, two weeks apart!

HDR Brachytherapy is no longer used as a monotherapy in the UK, although it used to be, and I know it is in the US. HDR is used in the form of HDR Boost for high risk patients (half dose as a single HDR fraction, and other half dose as multiple EBRT fractions).

Originally Posted by: Online Community Member
They would be using Spaceoar to protect the rectum. However, there are still acute and late toxicities involved. I only hear percentages…! 

I know of guys having brachytherapy as their first treatment but haven’t heard about “salvage” HD BT after EBRT… Are you familiar with this salvage treatment being used on anyone?

I run the Prostate Brachytherapy UK Support Group, and we don't have any members who've had HDR Brachy as a salvage treatment as far as I know.

 
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