Just started IMRT with brachytherapy later

prezmic

53 years of age. PSA 9.2 Gleason 3+4. 60% of 12 cores positive in biopsy. DRI can feel lumps on left side of prostate. All this diagnosed in April 2011.

I was first convinced I would have DaVinci. I am on the larger side, and the surgeon suggested I explore IMRT as alternative. Guess he wanted me to research all options. After studying more and consulting with radiation specialist - I decided on IMRT with brachytherapy. 25 treatments then seeds after 4-6 weeks.

I have just completed my 5th IMRT treatment and am positive this is the best course of action for me. As expected - no side effects as yet. My decision was based on my fear of ED and incontinence.

I will continue to post my progress.

lewvino

Best wishes to you on your
Best wishes to you on your journey. We look forward to reading about your continued success.

lewvino

robert1

Welcome to the Club
Hello prezmic:

We have a lot in common. My PSA is a bit lower (3.5) and my DRE was negative, but 60% of my cores were positive and your decision making was very similar to mine. I have now completed 14 IGRT treatments out of a scheduled 29. Seeds will follow 2-6 weeks after.

You probably alreay know this, but incontinence is rarely an issue with your choice. This is well documented and appears to be vastly better than surgery. It was a primary factor in my decision. Even so, temporary urinary issues are somewhat common with RT.


As for ED, it is obvious that the more sexually active you stay during and after treatment, the better off you will be. The impotence rates are higher than I would have liked for our choice of treatment, but still appear to be manageable...especially at your age.

In any event, the evidence would support your decision even if you only considered cure rates. In the hands of an experienced radiation oncologist, low risk patinet odds are in the mid to upper 90% range. In the hands of an experienced surgeon, they are probably in the upper 80% range.

You should however be staged as an intermediate risk patient, and I have not seen anything to suggest that IMRT/IGRT + seeds is not historically the most successful possible choice you could have made. While the 5-10-15 year cure rate results fall off a bit for intermediate risk guys regardless of treatment option, your choice is very well documneted and remains superior to any other surgical or RT choice.

Good luck with your treatments.

robert1

prezmic

robert1 said:

Welcome to the Club
Hello prezmic:

We have a lot in common. My PSA is a bit lower (3.5) and my DRE was negative, but 60% of my cores were positive and your decision making was very similar to mine. I have now completed 14 IGRT treatments out of a scheduled 29. Seeds will follow 2-6 weeks after.

You probably alreay know this, but incontinence is rarely an issue with your choice. This is well documented and appears to be vastly better than surgery. It was a primary factor in my decision. Even so, temporary urinary issues are somewhat common with RT.


As for ED, it is obvious that the more sexually active you stay during and after treatment, the better off you will be. The impotence rates are higher than I would have liked for our choice of treatment, but still appear to be manageable...especially at your age.

In any event, the evidence would support your decision even if you only considered cure rates. In the hands of an experienced radiation oncologist, low risk patinet odds are in the mid to upper 90% range. In the hands of an experienced surgeon, they are probably in the upper 80% range.

You should however be staged as an intermediate risk patient, and I have not seen anything to suggest that IMRT/IGRT + seeds is not historically the most successful possible choice you could have made. While the 5-10-15 year cure rate results fall off a bit for intermediate risk guys regardless of treatment option, your choice is very well documneted and remains superior to any other surgical or RT choice.

Good luck with your treatments.

robert1

Thanks for the endorsement
Robert,

Please keep me informed as you are ahead of me in the process. I will be eager to hear of what I can expect. This website/forum has been invaluable in my decision making process.

I spent 4 months studying my options and talking to several doctors. Fortunately, I was not limited by my insurance carrier on my choices. All options were on the table. Most were easily eliminated for various reasons. I am glad to hear that you concur that I made the correct choice.

I am in agreement that the impotence issue is manageable. Where there is a will, there is a way.

As for long term cure rates, I think (hope) that in 15-20 years, if I need further treatments that there will be far better pharmaceutical products available. Several of the RT doctors seem to think so.

Good luck to you as well.

Mike

mrspjd

robert1 said:

Welcome to the Club
Hello prezmic:

We have a lot in common. My PSA is a bit lower (3.5) and my DRE was negative, but 60% of my cores were positive and your decision making was very similar to mine. I have now completed 14 IGRT treatments out of a scheduled 29. Seeds will follow 2-6 weeks after.

You probably alreay know this, but incontinence is rarely an issue with your choice. This is well documented and appears to be vastly better than surgery. It was a primary factor in my decision. Even so, temporary urinary issues are somewhat common with RT.


As for ED, it is obvious that the more sexually active you stay during and after treatment, the better off you will be. The impotence rates are higher than I would have liked for our choice of treatment, but still appear to be manageable...especially at your age.

In any event, the evidence would support your decision even if you only considered cure rates. In the hands of an experienced radiation oncologist, low risk patinet odds are in the mid to upper 90% range. In the hands of an experienced surgeon, they are probably in the upper 80% range.

You should however be staged as an intermediate risk patient, and I have not seen anything to suggest that IMRT/IGRT + seeds is not historically the most successful possible choice you could have made. While the 5-10-15 year cure rate results fall off a bit for intermediate risk guys regardless of treatment option, your choice is very well documneted and remains superior to any other surgical or RT choice.

Good luck with your treatments.

robert1

robert1
Robert,

You’ve referred to your PCa risk status as intermediate, with many cores positive. In addition to the stats you provided in your initial thread/post (in April), wondering if you might share your PSA history and what factor(s) (other than life insurance) contributed to your doctor recommending the biopsy that led to tx (since you indicated your DRE was negative). Also, another poster previously inquired whether add'l diagnostic testing with an E-MRI was done (in addition to a negative CT &/or bone scan for distant mets) to rule out ECE, especially considering the PNI & high volume of PCa you indicated was found on biopsy. Did you ever have the E-MRI with Tesla 3 technology and if so, would you be open to sharing the results?

Sharing this info may be helpful in providing add’l perspective about your tx choices, particularly because if ECE is identified locally (for example, in the seminal vesicle(s) and/or local pelvic lymph nodes), then IMRT w/brachy seeds (aka Low Dose Rate Brachy) is not the only or "superior" RT choice for high volume, locally advanced, non-mets PCa. Other tx combinations/options exist (such as High Dose Rate-Brachy aka HDR-B w/IMRT) and have long term success rates, low rates of BCR, and few or temporary, short and long term side effects, with an impressive track record (10-15 yr study findings) in the tx of intermediate/high risk PCa, especially in cases where ECE is present. In addition, recent study findings have confirmed that adding a short course of ADT to IMRT txs (vs IMRT alone) increased overall survival rates. ADT can slow and shrink PCa tumor cell growth, and side effects for most men are temporary in short course ADT protocols.

Hope your txs continue to go smoothly, now and in the future.

mrs pjd

VascodaGama

prezmic said:

Thanks for the endorsement
Robert,

Please keep me informed as you are ahead of me in the process. I will be eager to hear of what I can expect. This website/forum has been invaluable in my decision making process.

I spent 4 months studying my options and talking to several doctors. Fortunately, I was not limited by my insurance carrier on my choices. All options were on the table. Most were easily eliminated for various reasons. I am glad to hear that you concur that I made the correct choice.

I am in agreement that the impotence issue is manageable. Where there is a will, there is a way.

As for long term cure rates, I think (hope) that in 15-20 years, if I need further treatments that there will be far better pharmaceutical products available. Several of the RT doctors seem to think so.

Good luck to you as well.

Mike

Better pharmaceutical products will surely be there
Prezmic

I hope your treatment goes “smooth as a feather” and that you will not be in need of such medicines in 15-20 years of time.
Could you share with us details of your protocol;
What will be the total dosage (Gys) of IMRT?
What about the Brachytherapy?
What are you expecting as a procedure for the Brachy?

I appreciate your info.

Wishing you a continuous eventless treatment and recovery.

VGama