Radio / Brachytherapy

I had a similar diagnosis to you (but PSA 25). I think you will get HDR, but you need to check that. My advice would be the same whether it is HDR or LDR though.

The order for mine was Brachy, EBRT but they can be swapped around. 

The short answer is you need both at the same time. 

The long answer is that there is a lifetime limit to how much RT your body's healthy cells can take. An oncologist will not risk giving you more than that limit, but equally will not risk giving you less than the that limit. It has to be killed, so no half measures.

Most of the cancer is in your prostate, but some is outside, and it may be further than just the Extension, so you need a moderate dose outside the prostate. Brachy puts the radioactive source in the prostate, each source has a range of about 3mm, so with multiple sources they can irradiate the whole prostate with a lot of radiation, whilst leaving anything more than 3mm from the prostate untouched. The EBRT can then further irradiate the prostate and the surrounding area with a much lower dose sweeping up any cancer outside the prostate.

Cancer always has some active cells and some dormant cells, the dormant cells will become active within about a week. Hitting the dormant cells with radiation does not harm them, so you need the RT spread out over at least a week so they will all have been active at some time during treatment. Leaving a long gap between Brachy and EBRT (either way around) would allow the unharmed dormant cells to become active and then regenerate. You would then have cancer, but have used up all your lifetime limit of RT.

You need the brachy *now*

Edited by member 04 Jan 2024 at 12:35  | Reason: Not specified

The treatment you describe is called Brachytherapy Boost (or HDR Boost or LDR Boost).

It combines the advantages of the two treatments...

External beam radiotherapy spills outside the prostate so it mops up micro-mets (mets too small to show on scans) which would be missed by prostatectomy or brachytherapy and cause recurrence.

Brachytherapy, because it's delivered directly into the prostate without passing through other tissues and has only a very short range, can deliver a higher effective dose into the prostate than can be done with external beam radiotherapy without causing extra side effects.

Brachytherapy Boost delivers around 60% of the standard external beam radiotherapy dose plus about 50% of the standard brachytherapy dose to the prostate and can include the seminal vesicles too if necessary (exact figures may be varied by patient). I had this treatment and I elected to have the external beam radiotherapy include all my pelvic lymph nodes too just in case there were any micro-mets in them (which is also done at 60% of the dose it would have been if there was known cancer in them). 4½ years after treatment, I would almost not know anything had been done (although I can't guarantee that for you).

LDR boost is quite rare but it can be done. LDR brachy can't be used above a certain Gleason score (because it takes 200 days to treat and you don't want to wait 200 days to finish treatment with an aggressive cancer), it has a max prostate size of around 55cc, and it can't treat T3b, all of which can be treated by HDR brachytherapy. HDR brachytherapy is not so good with small/normal prostates, but handles large prostates fine.

Edited by member 05 Jan 2024 at 10:14  | Reason: Not specified

Hi G oose , I only had Low dose Brachytherapy and no other treatment. Also 5 out of 20 samples taken positive.

John.

Edited by member 04 Jan 2024 at 16:23  | Reason: Not specified