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HDR Brackytherapy

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User
Posted 11 Jun 2023 at 19:07

Hi All,


I’m 55 recently diagnosed.


PSA 7.4, Gleason 7 and been offered HDR Brackytherapy which I’m pleased about but I am concerned about reoccurrence and the treatment options.


I’d be very grateful for anyone’s experience of HDR Brackytherapy.


thanks


 

User
Posted 12 Jun 2023 at 12:49

Originally Posted by: Online Community Member


My limited understanding, (my head is spinning), is that prostatectomy reduces the risk of reoccurrence, but has the fairly life changing side effects. HDR potentially much reduced side effects, if any, but possibly a higher chance of reoccurrence



That is a reasonable summary. The difference between the chance of recurrence in the next ten years between the two treatments is very small. If you have micro-mets, which nobody knows about, you will get recurrence with either treatment, fairly soon.


On a longer timescale ten years plus. Then a prostatectomy means you have not got a prostate so it is impossible for a new cancer to start, whereas HDR does leave you with a prostate and a chance of getting a new cancer.


An operation on a "fried" prostate is considered very tricky, it will be scarred and fused with adjacent tissue.


In reality if the primary treatment fails you are on a slippery slope, so consideration of what salvage treatment is available shouldn't be too high on your priority list.

Edited by member 12 Jun 2023 at 17:33  | Reason: Not specified

Dave

User
Posted 15 Jun 2023 at 00:35

Originally Posted by: Online Community Member



From the very limited evidence at my disposal, I would suggest that a higher percentage of men achieve relatively good control of peeing after a few months of RARP and that it would appear that probably half of men achieve erections after a year - of those that don't, some resort to mechanical or pill based aids or find alternative ways of enjoying sex. 



 


NHS data is that about 40% of men can get a natural erection at 12 months post-op, and about 90% can get an erection either naturally or by using a vacuum pump or meds. A significant proportion of those men cannot get sufficiently hard for penetrative sex though.  

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 15 Jun 2023 at 09:49
We used to have an annual get-together for forum members, with a speaker. For the last 3 years before the meetings stopped, we had one of the leading research oncologists in the UK and he said that, in the future, people will look back and be horrified and aghast that prostates were ever removed surgically!

My husband would have had brachytherapy if it had been available to him but it wasn't. We have plenty of examples on here of successful brachy treatment.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 15 Jun 2023 at 09:53
PS when searching for old threads here or for some of the UK / EU research (you don't need to rely just on US data as there is plenty in the EU) you will have more success by spelling it with an h rather than a k
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
Posted 12 Jun 2023 at 00:03

Well I was 53 at diagnosis, PSA 25, Gleason 9, T3a. The treatment with the highest chance of curing me was HDR, EBRT, and HT. So that is what I had. If your tumour is T1 or T2 then other treatments have a good chance of being successful.


You haven't said what stage your tumour is, but I will assume that as surgery or HIFU has not been mentioned that you are T3. 


Once the tumour is T3 a treatment which extends beyond the confines of the prostate is almost certainly required, hence some form of radiotherapy. Surgery in conjunction with RT is possible, but you then have two sets of side effects to contend with, and in general the side effects of surgery are likely to be worse than those of RT.


Recurrence is just a risk we have to accept. It is true that if the cancer is T1 or T2 surgery is very likely to remove the cancer and any chance of it recurring, but possibly with side effects worse than HDR.


I am five years post diagnosis and have a PSA of 0.1 and very few side effects. Things could change at the next PSA test, but whilst PSA is low I'm happy.

Dave

User
Posted 12 Jun 2023 at 06:43

Hi Dave,


Many thanks for your reply, much appreciated. Very pleased, & reassured, to know your treatment was successful. 


You are correct, my MRI showed a T3 tumour.


My dilemma is that they have offered a prostatectomy or two HDR Brackytherapy sessions, active surveillance not really an option. HDR seemed to be preferred. My limited understanding, (my head is spinning), is that prostatectomy reduces the risk of reoccurrence, but has the fairly life changing side effects. HDR potentially much reduced side effects, if any, but possibly a higher chance of reoccurrence? My primary concern is also with HDR the possibility of no curative option if it does reoccur, just HT to slow the spread? 


My consultant told me prostatectomy surgery following HDR was ‘more complicated’ but didn’t elaborate. I’m going to ask for more information on this, but would be grateful for your understanding if it or if anyone else has any experience around it?


Many thanks again,


Gary


 

User
Posted 12 Jun 2023 at 12:49

Originally Posted by: Online Community Member


My limited understanding, (my head is spinning), is that prostatectomy reduces the risk of reoccurrence, but has the fairly life changing side effects. HDR potentially much reduced side effects, if any, but possibly a higher chance of reoccurrence



That is a reasonable summary. The difference between the chance of recurrence in the next ten years between the two treatments is very small. If you have micro-mets, which nobody knows about, you will get recurrence with either treatment, fairly soon.


On a longer timescale ten years plus. Then a prostatectomy means you have not got a prostate so it is impossible for a new cancer to start, whereas HDR does leave you with a prostate and a chance of getting a new cancer.


An operation on a "fried" prostate is considered very tricky, it will be scarred and fused with adjacent tissue.


In reality if the primary treatment fails you are on a slippery slope, so consideration of what salvage treatment is available shouldn't be too high on your priority list.

Edited by member 12 Jun 2023 at 17:33  | Reason: Not specified

Dave

User
Posted 12 Jun 2023 at 13:54

Originally Posted by: Online Community Member


My limited understanding, (my head is spinning), is that prostatectomy reduces the risk of reoccurrence, but has the fairly life changing side effects.


 


I think that this is the psychological side of the procedure - balancing the two primary side effects (incontinence and erectile dysfunction) and how these would affect your life and mental well-being.

Both can be short-term or long-term and mild or severe and that's down to the individuals medical situation.

From the very limited evidence at my disposal, I would suggest that a higher percentage of men achieve relatively good control of peeing after a few months of RARP and that it would appear that probably half of men achieve erections after a year - of those that don't, some resort to mechanical or pill based aids or find alternative ways of enjoying sex. As I said, that's purely a guesstimate and only you can decide on how you could cope with either of these and if the psychological benefits of having the prostate completely removed outweigh them.

Good luck with whatever you decide is best for you.

User
Posted 12 Jun 2023 at 17:43
"My limited understanding, (my head is spinning), is that prostatectomy reduces the risk of reoccurrence, but has the fairly life changing side effects. HDR potentially much reduced side effects, if any, but possibly a higher chance of reoccurrence?"

No, with a T3 diagnosis the opposite is true. With a T3 the chance of leaving some cancer behind in the op is much higher whereas brachytherapy and / or external RT can hit a wider area and make recurrence less likely.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 13 Jun 2023 at 14:33

Many thanks Steve that’s very helpful,  I need another chat with my consultant.


I think it’s significant that there doesn’t appear to be many people who’ve had just HDR. 


regards


Gary

User
Posted 13 Jun 2023 at 14:34

Many thanks Lyn, 


 

User
Posted 14 Jun 2023 at 21:09

Hi Dave,


I’ve found there is a large corpus of academic research available on Brackytherapy carried out in Canada. From the studies I’ve seen I suspect you’ve had the current gold standard in treatment for your test results/levels.


 


https://youtu.be/jY9oZ6iiVq4


 


It’s Bracktherapy for me 100%

Vive la life! 


thanks again


gary

User
Posted 15 Jun 2023 at 00:18

Yes, my cancer was very high risk, but still a T3. They chucked nearly everything at it. Thanks for the YouTube link. Very reassuring as my PSA has generally been at or below 0.1 post treatment with a little blip to 0.2 on one test. So according to this video I probably have 97% chance ten year disease free survival. Prior to this video the best evidence I had was about 66% at ten years.


I am educated as a scientist, but i take medical research with a pinch of salt, it is surprising how much bias can sneak into research. But without research we have nothing so as long as it is viewed with healthy scepticism it has value.


For the lay person, which we all are when first diagnosed, there is a very strong emotional bias towards surgery, again healthy scepticism will hopefully lead to the right treatment choice for the right patient, which may be surgery for a localised tumour, but for a widespread tumour should probably involve RT.

Dave

User
Posted 15 Jun 2023 at 00:35

Originally Posted by: Online Community Member



From the very limited evidence at my disposal, I would suggest that a higher percentage of men achieve relatively good control of peeing after a few months of RARP and that it would appear that probably half of men achieve erections after a year - of those that don't, some resort to mechanical or pill based aids or find alternative ways of enjoying sex. 



 


NHS data is that about 40% of men can get a natural erection at 12 months post-op, and about 90% can get an erection either naturally or by using a vacuum pump or meds. A significant proportion of those men cannot get sufficiently hard for penetrative sex though.  

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 15 Jun 2023 at 09:39

Agreed, & me too, MSc from Strathclyde.


I sometimes get the impression some scientists would sell their first born to get published.
I’m reassured by the fact that the consultant giving teams lecture is one the leading authorities on Radiotherapy, and Chair of American Centre of Brackytherapy research. Her studies/findings also chime with what two senior urology consultants have already told me at UHW Cardiff. 
I know nothing is black & white is our situation, & still could be grasping, but still think it very positive. I’ve contacted both the university of British Columbia & American Centre of Brackytherapy requesting links to the latest studies, I’ll post them if I get anything.


All very best to you and the very best of luck for us both! 


 

User
Posted 15 Jun 2023 at 09:49
We used to have an annual get-together for forum members, with a speaker. For the last 3 years before the meetings stopped, we had one of the leading research oncologists in the UK and he said that, in the future, people will look back and be horrified and aghast that prostates were ever removed surgically!

My husband would have had brachytherapy if it had been available to him but it wasn't. We have plenty of examples on here of successful brachy treatment.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 15 Jun 2023 at 09:53
PS when searching for old threads here or for some of the UK / EU research (you don't need to rely just on US data as there is plenty in the EU) you will have more success by spelling it with an h rather than a k
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
 
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