Treatment Options

hopeful and optimistic
hopeful and optimistic Member Posts: 2,346 Member
edited April 2011 in Prostate Cancer #1
Mac,as a 68 year old, in good health with low numbers for the last two years, my viewpoint toward AS is the same as yours......... I am also inclined toward Robotic Surgery, CyberKnife, as well as Temporary Seeds in the event that my cancer spreads or becomes more aggressive....I would like to decide which of these three active treatments is best so I can quickly take action at that time.....frankly at this point, I don't know what one is "best"


I am thankful for any insight(s) from posters toward one treatment that is better than the others; mainly in regard to outcome, not convenience.

Comments

  • VascodaGama
    VascodaGama Member Posts: 3,701 Member
    #2
    Hopeful
    If AS is working, do
    Hopeful
    If AS is working, do not change or thing in changing. All treatments have side effects and their success depends on many factors, which may change along the years of your survival.
    VG
  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,346 Member
    #3
    VascodaGama said:

    Hopeful
    If AS is working, do
    Hopeful
    If AS is working, do not change or thing in changing. All treatments have side effects and their success depends on many factors, which may change along the years of your survival.
    VG

    Thanks Vasco
    Appreciate your input.......my post was misleading.....I plan to continue with Active Surveillance as long as I can....at this point I am gathering information on other treatment options, if my cancer progresses.
  • Swingshiftworker
    Swingshiftworker Member Posts: 1,017 Member
    #4
    Who is Mac?
    H&O: As a very active poster here, I find it interesting that you are still pondering what treatment choices to make if your PCa spreads or becomes more aggressive following Active Surveillance.

    If your PCa progresses that far, I think that you will limit your choices only to surgery, EBT or IMRT and/or chemo and/or hormone therapy. Surgery is not an option if the PCa migrates beyond the prostate and CK (SBRT) and brachytherapy (BT) are NOT options for advanced forms of PCa.

    All methods of treatment for early PCa have about the same measured effectiveness, but their side effects range dramatically between surgery (which IMHO is the worst) to CK (which IMHO is the best). So, if you're interested in treating your PCa with the least possible side effects, the time to choose CK or BT would be now, not later after you find out that the PCa has become more advanced and/or aggressive. The effectiveness of treatments for advanced PCa is questionable and variable depending on the nature and extent of the cancer. The only thing for sure -- if you have advanced PCa your options are limited and the treatments are all awful.

    BTW, I don't think there is any such thing as "temporary seeds". Any radioactive seeds placed in your prostate via BT will have a 1/2 life of about a year but those seeds remain in your body FOREVER, which is one reason I chose NOT to receive that form of treatment. The other reason was that it was not as precise as CK, which I chose instead.

    Good luck!
  • Kongo
    Kongo Member Posts: 1,166 Member
    #5
    Swingshiftworker said:

    Who is Mac?
    H&O: As a very active poster here, I find it interesting that you are still pondering what treatment choices to make if your PCa spreads or becomes more aggressive following Active Surveillance.

    If your PCa progresses that far, I think that you will limit your choices only to surgery, EBT or IMRT and/or chemo and/or hormone therapy. Surgery is not an option if the PCa migrates beyond the prostate and CK (SBRT) and brachytherapy (BT) are NOT options for advanced forms of PCa.

    All methods of treatment for early PCa have about the same measured effectiveness, but their side effects range dramatically between surgery (which IMHO is the worst) to CK (which IMHO is the best). So, if you're interested in treating your PCa with the least possible side effects, the time to choose CK or BT would be now, not later after you find out that the PCa has become more advanced and/or aggressive. The effectiveness of treatments for advanced PCa is questionable and variable depending on the nature and extent of the cancer. The only thing for sure -- if you have advanced PCa your options are limited and the treatments are all awful.

    BTW, I don't think there is any such thing as "temporary seeds". Any radioactive seeds placed in your prostate via BT will have a 1/2 life of about a year but those seeds remain in your body FOREVER, which is one reason I chose NOT to receive that form of treatment. The other reason was that it was not as precise as CK, which I chose instead.

    Good luck!

    Temporary Seeds
    Swing,

    Actually, I think Hopeful and Optimistic was referring to HDR brachytherapy which, as you know, uses a similar dosage pattern as normal brachytherapy except that the radiation internal to the prostate is temporary. They insert several plastic tubes positioned by a matrix into the prostate via the perineum and then insert radioactive rods (actually wires) in and out of the tubes based on the dosage plan. I think because of the similar word usage of brachytherapy some use it interchangeably.

    Brachy comes from the Greek word "short" and in this meaning it is placing the radiation a short distance from the tumor. The opposite of brachy is "tele" (hence the word telescope) which is therapy from a greater distance to the tumor. So, external radiation could also be called teletherapy although that is not common usage.

    Aren't words great?

    K
  • Swingshiftworker
    Swingshiftworker Member Posts: 1,017 Member
    #6
    Kongo said:

    Temporary Seeds
    Swing,

    Actually, I think Hopeful and Optimistic was referring to HDR brachytherapy which, as you know, uses a similar dosage pattern as normal brachytherapy except that the radiation internal to the prostate is temporary. They insert several plastic tubes positioned by a matrix into the prostate via the perineum and then insert radioactive rods (actually wires) in and out of the tubes based on the dosage plan. I think because of the similar word usage of brachytherapy some use it interchangeably.

    Brachy comes from the Greek word "short" and in this meaning it is placing the radiation a short distance from the tumor. The opposite of brachy is "tele" (hence the word telescope) which is therapy from a greater distance to the tumor. So, external radiation could also be called teletherapy although that is not common usage.

    Aren't words great?

    K

    Thanks for the clarification, Kongo
    You're probably right about the "temporary seeds" reference, but to address H&O's question, I don't think HDR is a choice for advanced PCa.

    It's an alternative to surgery, LDR BT ("permanent" seeds) and other forms of treatment for early stage PCa but, if the PCa becomes more advanced/aggressive and has spread beyond the prostate, all bets are off and, as far as I know, the choices are then limited to EBRT (and maybe IMRT), chemo and hormone therapy with variable effectiveness depending on the individual nature of the cancer.
  • Kongo
    Kongo Member Posts: 1,166 Member
    #7
    Swingshiftworker said:

    Thanks for the clarification, Kongo
    You're probably right about the "temporary seeds" reference, but to address H&O's question, I don't think HDR is a choice for advanced PCa.

    It's an alternative to surgery, LDR BT ("permanent" seeds) and other forms of treatment for early stage PCa but, if the PCa becomes more advanced/aggressive and has spread beyond the prostate, all bets are off and, as far as I know, the choices are then limited to EBRT (and maybe IMRT), chemo and hormone therapy with variable effectiveness depending on the individual nature of the cancer.

    Advanced options
    Actually, Swing, HDR is used for many men with intermediate and high risk PCa. Like most other treatments, it is not appropriate if the cancer has migrated beyond the prostate.

    Mrspjd may wish to comment on it as I believe she is very well informed on its use as her husband had this therapy with his Gleason 7 PCa diagnosis.

    K
  • mrspjd
    mrspjd Member Posts: 694 Member
    #8
    Kongo said:

    Advanced options
    Actually, Swing, HDR is used for many men with intermediate and high risk PCa. Like most other treatments, it is not appropriate if the cancer has migrated beyond the prostate.

    Mrspjd may wish to comment on it as I believe she is very well informed on its use as her husband had this therapy with his Gleason 7 PCa diagnosis.

    K

    HDR-B
    HDR-B (High Dose Rate Brachytherapy) is usually referred to as a temporary form of Brachy. Some have referred to HDR-B as “temporary seeds” but that is a misnomer. HDR-B is a PCa tx used to apply/deliver a high rate radiation dosing “boost” directly into the prostate gland & can also be applied to the seminal vesicle(s) if there is evidence of local spread/advance to that region. It can vary in # of txs & sessions, be used as a sole primary tx or, for more locally advanced PCa, it can be used neo-adjuvantly with IG/IMRT (Image Guided/Intensity Modulated Radiation Therapy) which would additionally radiate the prostate bed and local lymph nodes. ADT, aka hormone therapy, may also be added to the tx protocol.

    Ten to fifteen years of study data exists for HDR-B showing successful tx outcomes for intermediate-high risk PCa, such as T3 staging. It is considered to be an effective and precise way to tx PCa (and other types of cancer also), since the HDR-B delivery method applies the dosing directly, eliminating the potential for missing the target due to any slight prostate movement, assuring the full dosing boost. Toxicity findings were generally unremarkable.

    HDR-B radiation is delivered by temporary insertion of radioactive iridium wire into flexible needles placed in the prostate through the perineum and removed after tx. It differs from the more commonly known Brachytherapy tx which involves implantation of permanent radioactive seeds into the prostate and, unlike permanent Brachy seeds, HDR-B poses no risk to others of radiation exposure after tx.

    Like any other PCa treatment, when considering HDR-B, it is essential to find an experienced and skilled rad onc with a specialty in HDR-B.
  • Swingshiftworker
    Swingshiftworker Member Posts: 1,017 Member
    #9
    Kongo said:

    Advanced options
    Actually, Swing, HDR is used for many men with intermediate and high risk PCa. Like most other treatments, it is not appropriate if the cancer has migrated beyond the prostate.

    Mrspjd may wish to comment on it as I believe she is very well informed on its use as her husband had this therapy with his Gleason 7 PCa diagnosis.

    K

    Duplicate Post Deleted

    Duplicate Post Deleted
  • Swingshiftworker
    Swingshiftworker Member Posts: 1,017 Member
    #10
    Kongo said:

    Advanced options
    Actually, Swing, HDR is used for many men with intermediate and high risk PCa. Like most other treatments, it is not appropriate if the cancer has migrated beyond the prostate.

    Mrspjd may wish to comment on it as I believe she is very well informed on its use as her husband had this therapy with his Gleason 7 PCa diagnosis.

    K

    Ok, I stand corrected. My
    Ok, I stand corrected.

    My impression was that HDR BT was being used just as an alternative to standard LDR BT for early stage PCa. Good to know that it can be used for more advanced PCa, except of course when the cancer has migrated beyond the prostate, seminal vesicles and/or lymph nodes.
  • kddh
    kddh Member Posts: 14
    #11
    mrspjd said:

    HDR-B
    HDR-B (High Dose Rate Brachytherapy) is usually referred to as a temporary form of Brachy. Some have referred to HDR-B as “temporary seeds” but that is a misnomer. HDR-B is a PCa tx used to apply/deliver a high rate radiation dosing “boost” directly into the prostate gland & can also be applied to the seminal vesicle(s) if there is evidence of local spread/advance to that region. It can vary in # of txs & sessions, be used as a sole primary tx or, for more locally advanced PCa, it can be used neo-adjuvantly with IG/IMRT (Image Guided/Intensity Modulated Radiation Therapy) which would additionally radiate the prostate bed and local lymph nodes. ADT, aka hormone therapy, may also be added to the tx protocol.

    Ten to fifteen years of study data exists for HDR-B showing successful tx outcomes for intermediate-high risk PCa, such as T3 staging. It is considered to be an effective and precise way to tx PCa (and other types of cancer also), since the HDR-B delivery method applies the dosing directly, eliminating the potential for missing the target due to any slight prostate movement, assuring the full dosing boost. Toxicity findings were generally unremarkable.

    HDR-B radiation is delivered by temporary insertion of radioactive iridium wire into flexible needles placed in the prostate through the perineum and removed after tx. It differs from the more commonly known Brachytherapy tx which involves implantation of permanent radioactive seeds into the prostate and, unlike permanent Brachy seeds, HDR-B poses no risk to others of radiation exposure after tx.

    Like any other PCa treatment, when considering HDR-B, it is essential to find an experienced and skilled rad onc with a specialty in HDR-B.

    Why Not for Low Risk?
    Hello--Although you wrote in much greater detail than I had known, I also encountered the HDR brachy in my "studies." What I am curious about, is why it is NOT done for low-risk PCa. Since the permanence of the seeds is the downside of conventional brachytherapy, I got excited about HDR until my urologist told me it wasn't used for low-risk. Do you happen to know why not?

    Many thanks for your commitment to this site!
  • mrspjd
    mrspjd Member Posts: 694 Member
    #12
    kddh said:

    Why Not for Low Risk?
    Hello--Although you wrote in much greater detail than I had known, I also encountered the HDR brachy in my "studies." What I am curious about, is why it is NOT done for low-risk PCa. Since the permanence of the seeds is the downside of conventional brachytherapy, I got excited about HDR until my urologist told me it wasn't used for low-risk. Do you happen to know why not?

    Many thanks for your commitment to this site!

    kddh
    kddh,

    Unsure who your post/question is addressed to and it’s unclear whether you’ve made a tx decision. FWIW, here’s my take (& others may wish to add their comments).

    It’s anybody’s guess why your urologist told you HDR-B was not used for low risk PCa or what factors may have contributed to your doctor’s incorrect “information/advice.” Indeed, HDR-B is a primary tx option for low risk PCa, as well as a tx option for intermediate-high risk (non-mets) PCa as described in my post dated April 9.

    Giving your urologist the benefit of the doubt, perhaps there were extenuating factors in your low risk PCa profile, such as preexisting health issues, that influenced his/her opinion. Maybe your doctor was unfamiliar with, or did not offer (for referral?), this particular tx and, instead, recommended a more familiar tx, one which he provided. Many urologists are surgeons, so it follows that they might suggest RP or even LDR-B (Low Dose Rate Brachy, aka permanent seeds).

    It’s always important to obtain multiple 2nd opinions, especially from specialists, such as experienced radiation oncologists and PCa oncologists. In the case of insurance & HMO’s, if possible, sometimes one has to look outside the realm of the HMO’s limited tx offerings to explore all PCa tx options.

    HDR-B requires a minimally invasive surgical procedure and usually requires an overnight stay in the hospital or clinic. If all pre tx diagnostic testing and a 2nd opinion biopsy pathology report confirm low risk PCa, there are several minimally invasive primary tx choices available such as IG/IMRT, SBRT, Active Surveillance, etc. However, no PCa tx is without risk of possible side effects.

    As I and others have often written, doing your own indepth PCa research, while sometimes burdensome and time consuming, is mandatory in order to be an educated patient. Only you can be your own best advocate when it comes to working with your medical team in order to make PCa tx choices that are right for you with the best chance for a successful outcome.

    Good luck on your journey.

    mrs pjd

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