Which first IMRT or Brachytherapy?

DaveRN94

Unlike some that post here, my radiation oncologist wants to do the "seeds" first, wait 2 months and do 25 fractions of IMRT (5 weeks, 5 days per week).

Does that make sense? Anyone else heard of that approach?

Kongo

More info
Hi Dave and welcome to the forum. Could you share more information about your diagnosis, age, health, and so forth?

K

DaveRN94

Kongo said:

More info
Hi Dave and welcome to the forum. Could you share more information about your diagnosis, age, health, and so forth?

K

More info
I will be 70 yrs old on Thanksgiving. I was diagnosed on Oct 18th with 2/12 cores positive with 4+4=8s, 20%--30% volume. The 2 positive cores are side-by-side. My PSA was 5.6 at dx. I am active and healthy otherwise.

My rediation oncologist wants to do seeds first and then 5 weeks of IMRT (5 days per week). Most men seem to have the EBRT first then the seeds. I was asking for thoughts on that. I love the knowledge base here. Thanks for your thoughts; it is obviously helpful to sort through all of this.

Dave

tarhoosier

DaveRN94 said:

More info
I will be 70 yrs old on Thanksgiving. I was diagnosed on Oct 18th with 2/12 cores positive with 4+4=8s, 20%--30% volume. The 2 positive cores are side-by-side. My PSA was 5.6 at dx. I am active and healthy otherwise.

My rediation oncologist wants to do seeds first and then 5 weeks of IMRT (5 days per week). Most men seem to have the EBRT first then the seeds. I was asking for thoughts on that. I love the knowledge base here. Thanks for your thoughts; it is obviously helpful to sort through all of this.

Dave

Seed Boost
Welcome Dave. The treatment you have been recommended is a good choice for someone like you. This is often referred to as External Beam with Seed Boost. You do not mention how many Grays (radiation quantity) will be delivered at each fraction (day) of treatment. If the fraction is 2 Gy per day for 25 days, then that is 50 Gy total. If 2.5 then your total IMRT is 62.5. Or some other number and total. The seeds provide a "boost" to this total for an in-gland radiation total of far higher. The IMRT has likely side effects, particularly as the total radiation amount accumulates, and the seeds add a smaller side effect range.
It is doctor choice which to do first. Some like a "fresh" gland for the seed insertion, others feel the external is to be done first. There is no "right" order. The key is to have the best man or woman conducting the treatment with the best equipment. Modern radiation is a kind of magic, but only if the magician has mastered the effect.
You do not mention if there was a recommendation for hormone treatment to accompany this radiation. It is often so done, though it may be avoided in some cases. Again, patient and doctor collusion is key in making this choice.

tarhoosier

DaveRN94 said:

More info
I will be 70 yrs old on Thanksgiving. I was diagnosed on Oct 18th with 2/12 cores positive with 4+4=8s, 20%--30% volume. The 2 positive cores are side-by-side. My PSA was 5.6 at dx. I am active and healthy otherwise.

My rediation oncologist wants to do seeds first and then 5 weeks of IMRT (5 days per week). Most men seem to have the EBRT first then the seeds. I was asking for thoughts on that. I love the knowledge base here. Thanks for your thoughts; it is obviously helpful to sort through all of this.

Dave

deleted

deleted

tarhoosier

DaveRN94 said:

More info
I will be 70 yrs old on Thanksgiving. I was diagnosed on Oct 18th with 2/12 cores positive with 4+4=8s, 20%--30% volume. The 2 positive cores are side-by-side. My PSA was 5.6 at dx. I am active and healthy otherwise.

My rediation oncologist wants to do seeds first and then 5 weeks of IMRT (5 days per week). Most men seem to have the EBRT first then the seeds. I was asking for thoughts on that. I love the knowledge base here. Thanks for your thoughts; it is obviously helpful to sort through all of this.

Dave

deleted

deleted

DaveRN94

tarhoosier said:

Seed Boost
Welcome Dave. The treatment you have been recommended is a good choice for someone like you. This is often referred to as External Beam with Seed Boost. You do not mention how many Grays (radiation quantity) will be delivered at each fraction (day) of treatment. If the fraction is 2 Gy per day for 25 days, then that is 50 Gy total. If 2.5 then your total IMRT is 62.5. Or some other number and total. The seeds provide a "boost" to this total for an in-gland radiation total of far higher. The IMRT has likely side effects, particularly as the total radiation amount accumulates, and the seeds add a smaller side effect range.
It is doctor choice which to do first. Some like a "fresh" gland for the seed insertion, others feel the external is to be done first. There is no "right" order. The key is to have the best man or woman conducting the treatment with the best equipment. Modern radiation is a kind of magic, but only if the magician has mastered the effect.
You do not mention if there was a recommendation for hormone treatment to accompany this radiation. It is often so done, though it may be avoided in some cases. Again, patient and doctor collusion is key in making this choice.

Thanks, tarhoosier
Appreciate helping me out on the order of seeds and IMRT. That was helpful.

Regarding ADT, my urologist wanted to start me on ADT; my radiation oncologist stated not being a fan of ADT, especially with my PSA and small tumor involment and age. He stated that if my PSA was 15 or more or other variable were different, he may take a different approach.

When I shared that info with my urologist, he stated being OK with that assesment, only stating that studies do seem to indicate increased long-term sucsess by adding ADT, considering my 2 4+4=8 GS. As for me personally, I am willing to take the calculated risk for the potential better QoL.

tarhoosier

DaveRN94 said:

Thanks, tarhoosier
Appreciate helping me out on the order of seeds and IMRT. That was helpful.

Regarding ADT, my urologist wanted to start me on ADT; my radiation oncologist stated not being a fan of ADT, especially with my PSA and small tumor involment and age. He stated that if my PSA was 15 or more or other variable were different, he may take a different approach.

When I shared that info with my urologist, he stated being OK with that assesment, only stating that studies do seem to indicate increased long-term sucsess by adding ADT, considering my 2 4+4=8 GS. As for me personally, I am willing to take the calculated risk for the potential better QoL.

Prognosis
Dave, I do not have access to the rest of your disease information. I assume your prostate is normal size. I assume your psa doubling time is relatively slow. I assume your pathologist was an expert and made the proper determination of cancer amount, location, and Gleason. I do not know what part of the gland these two cores were located. There is much else unknown, including your medical history. With all of these qualifiers and limitations, I still feel confident saying that you are more likely to die of some other condition than your prostate caner, assuming you follow your doctors suggestions and treatment plans. This means you must maintain proper respect for the rest of your body and the issues therein.
One of the major changes that happened to me at my diagnosis was a sudden sense of being an unhealthy man. In fact, I am a healthy man with this single chronic condition which limits me in the bedroom, but nowhere else. And that limitation was inevitable, under any circumstances. You may not have even that limitation.
Go forth and enjoy your life. it is yours to live.

DaveRN94

tarhoosier said:

Prognosis
Dave, I do not have access to the rest of your disease information. I assume your prostate is normal size. I assume your psa doubling time is relatively slow. I assume your pathologist was an expert and made the proper determination of cancer amount, location, and Gleason. I do not know what part of the gland these two cores were located. There is much else unknown, including your medical history. With all of these qualifiers and limitations, I still feel confident saying that you are more likely to die of some other condition than your prostate caner, assuming you follow your doctors suggestions and treatment plans. This means you must maintain proper respect for the rest of your body and the issues therein.
One of the major changes that happened to me at my diagnosis was a sudden sense of being an unhealthy man. In fact, I am a healthy man with this single chronic condition which limits me in the bedroom, but nowhere else. And that limitation was inevitable, under any circumstances. You may not have even that limitation.
Go forth and enjoy your life. it is yours to live.

Prognosis
Very encouraging words! Thanks you so very much. I am in absolutely excellent health, with the exception of this intruder. Regarding the location of the two cores, they are right and lateral base, so side-by-side with 20% and 30% volume.

I would like to understand a little better about what you mean by being limited in the bathroom, only if you care to. I know we are all a little different bur similar.

Thanks again for your words. I want to live my life, for it certaily is a gift. At this stage, my thoughts often are flooded with thoughts of how to deal with this and the what ifs of the next few months and what life will be like when all of the treatment ends, and when the monitoring begins.

My goal before all of this became know to me was to stay healthy and stay out of the health care system. Now I am in it and at its mercy. Sometimes I feel they are more interested in looking at my healthcare card than knowing me as a person.

As they say, "It is what it is.: :>)