LD Brachytherapy versus IMRT

Hi D

I had  IMRT with the gold markers ,  was easy and 7 yes on still ok.

I have read quite a bit about LDR Brachy , seems as good as external beam but I think it's  done  under GA which would put me off.

However, I could be wrong so don't let me put u off, just look online and also check out side effects for both.

Good luck

Steve 

Hi Steve

Thanks for your reply.

LD Brachy appeals but I am still undecided, hence my post.

I take your point about GA.  I too would not want GA.  However, spinal anaesthesia is available with LDB.

The side effects for LDB 'seem' less than IMRT.

The gold fiducials would not be available to me with IMRT.

In some papers LDB ranks higher than EBRT with or without HT.

The thought of having 80+ metal seeds permanently injected into your prostate makes me wince a bit!

Dedalus

Actually I think it's IGRT that includes the markers, more targeted.

Yes 80 seeds does seem rather a lot but then LDR Brachy been around a while so must be ok

Just do  much research before deciding but am sure you've done plenty of that.

I feel sure that side effects are similar, any side effects I had fizzled out a few weeks after treatment finished.

Best wishes

Steve 

Thanks Steve

I would be interested to know, what was your stage, grade, and was your PCa on one side of your prostate or both?

Please don't  feel you have to provide that info.

I am interested to make a comparison as my PSA was 13.1, 6 months ago.  Although it was 14.33 4 months later.

Dedalus

Sure

I initially had 2 tumours,  largest starting at 3mm and growing to 13mm over 4 years on  AS. Near treatment they think they spotted a third. Both sides I think.

PSA went from about 4 to 13 over the 4 years , Gleeson 6.

Tumour was still contained in the gland but getting near the edge.

So I suppose cos stats low helped it to be successful.

Hope that helps

Steve 

Thanks Steve.

The reason I asked was because I knew you didn't have HT which I want to avoid, and thus to compare stats.

LD Brachy is usually offered without HT,  and is virtually as good as EBRT with HT, so would suit my aspirations.

I wouldn't therefore feel I was taking such a risk as with refusing HT with EBRT.  It would be standard LDB protocol.

My main concern at the moment is the time to treatment.  I am concerned that a 14mm tumour in a 36cc prostate could be getting close to the edge of the capsule.  They have not told me how close it is despite asking.  My MRI was almost 2 months ago and I have another month before my oncology appointment, just to discuss treatment.

Dedalus

Ok, I didn't know that ,  no HT with Brachy, a big plus Def.

I think Brachy possibly only done with lowish stats which yours seem to be , not sure on your Gleeson.

Probably doesn't work so well if escaped the gland cos HT would be required.

I know what  mean about asking them for tumour detail,  I asked if they could show me the tumour on the MRI , they wouldn't, I complained, that made it all worse and I changed hospital.

Steve 

Hello Dedalus 

I am aware of your concerns here - two points I would make:

* Brachytherapy isn't available everywhere - you need to ensure your team are willing to offer it.

* I know you wish to avoid HT at all costs but if that tumour is ready to go "walkabout" your choices will be reduced. My personal option would be to start HT to ensure the buggers don't go anywhere. You can always come off it and it works from day 1.

Best wishes - Brian.

Thanks Brian

I take your point re the tumour and it does worry me considering the delays I have experienced.

You are correct ND Brachy is not available at my large regional hospital.  It is available 130 miles away and is about the only treatment I can be referred to another hospital for.  There are selection criteria, which I may not satisfy.

Due to my CKD specifically, H.T. can be detrimental, to my solitary underperforming kidney, but I am concerned about HT generally as you have probably gathered!

What in your opinion would be the minimum period for HT for localised, intermediate-grade PCa.?   The uirologist said I was T2a but conceded I could be T2c when I pressed him that I also have a tiny 3+3 sample on the right side of my prostate ie 1 core out of 6 and 1% I think.  I am Gleason 3+4 on the left side with 90% 3 and 10% 4 ie 1.3mm, 5mm, and 9mm.

I think the US.  NCCN classifies the above as infavourable intermediate, which is possibly more negative than NICE.

Dedalus

Thanks again Steve.

They have been quite casual and unspecific about the position of the tumour in relation to the capsule.  I would really like to have a more definite answer.

I can't change hospital, even if I wanted to.

The urologist said I was T2a but conceded I could be T2c when I pressed him that I also have a tiny 3+3 sample on the right side of my prostate ie 1 core out of 6 and 1% I think.  I am Gleason 3+4 on the left side with 90% 3 and 10% 4 ie 1.3mm, 5mm, and 9mm.

Dedalus