New to board with my story and looking for Brachytherapy info

hopeful and optimistic said:

Second opinion of both biopsies
I suggest that you get a second opinion of both biopsies from an independent third party expert pathologist. Boswick, who probably analyzed the PCA3 is one, and Johns Hopkins is another.

Swingshiftworker said:

Also consider CK and PBT
Sounds like you have a pretty good grasp of the risks of surgery. If you haven't seen it yet, I suggest you read the following article which should give you good reason to think of another form of treatment -- even with a Gleason 7 diagnosis:

http://www.hifurx.com/prostate-cancer/prostate-cancer-after-effects.

As for brachytherapy (BT), it has a good overall track record with a lot of clinical data. However, BT is also not w/o it's own risks. The quality of LDR (low dose rate) BT as a treatment depends largely on the precision of the treatment plan -- ie. the accuracy of the dosage and placement of the seeds. If the dosages are incorrect (too high at particular locations and if the location of the seeds is imprecise, there is a risk of collateral tissue damage that can result in ED, incontinence and other problems. The problem w/LDR BT is also that the seeds can migrate and/or get passed out when you pee (f***ing up the treatment plan) and the seeds also remain in your prostate forever (which in the short term makes you radioactive that can create problems for you at the airport and limit your contact w/pregnant women and young children during at least the 1st year following treatment).

If you are set on BT, I suggest you consider HDR (high dose rate) BT instead which only places the seeds in your prostate temporarily. It's kind of like external beam radiation treatment (EBRT) only the radiation is placed internally for a short duration so that the radiation gets the job done w/o passing through other tissue and you are no longer radioactive after the seeds are removed. Treatment again is only as good as the plan but you don't have to worry about seed migration and continuing radioactivity.

However, if you're really worried about your quality of life following treatment, I strongly suggest you look into CyberKnife (CK) and Proton Beam Therapy (PBT) as alternatives. I and several men here have been treated w/CK without any significant side effects -- no ED and no incontinence. However, one man did experience a significant infection following the placement of fiducials prior to treatment, which is a risk connected w/any transrectal penetration (including biopsies). CK only requires 4-5 treatments over a week and incorporates a degree of precision in radiation placement that exceeds all other EBRT methods. There have been clinical studies involving CK showing suggest over 5 years but nothing longer than that. There's a patient forum monitored by doctors to use CK on Accuray's (the mfg) website here: http://cyberknife.com/forum.aspx?g=topics&f=2586.

If you need long term studies to give you confidence in the method, then you should consider PBT instead. It has a track record over 10 years w/reported success and limited accounts of ED and/or incontinence following treatment. PBT takes longer and is more cumbersome than CK because it requires about 40 daily treatments over 8 weeks at a limited number of treatment sites around the country. You have to be fitted for a body cast to prevent movement during treatment (not required for CK because the computer program adjusts for body AND organ movement during treatment) and you have to have a water filled ballon inserted in your **** before each treatment to protect your rectum from damage. There are a lot of ex-PBT patients (but not many here) and a big online support group called BOB (Brotherhood of the Balloon --a reference to the water balloon and Bob Marchiki who wrote a book on the treatment) where you can get more detailed info.

Both CK and PBT are covered by insurance but whether your policy will cover it or not will depend on who your carrier is. Some carriers still consider both CK and PBT "experimental" and will not cover them but other carriers do not hold this opinion and will pay for the treatments. The other question about CK and PBT is whether you can get treatment w/a diagnosis of Gleason 7 and PSA 14. Heretofor, CK and PBT have been limited to patients w/Gleason 6 an PSA 10 in order to improve the conditions for success (necessary for positive clinical study results and FDA/medical insurance approval). However, things are changing and providers now seem to be expanding the scope of the patients treated w/CK and PBT to those with more serious cancers.

BTW, HiFu (high intensity frequency ultrasound) is reported as being equally successful (with minimal side effects) in the treatment of early stage PCa, but it is considered experimental by the FDA and is not covered yet (as far as I know) by any medical insurance carriers. The cost is $25k plus travel expenses to Canada, the Carribean or Mexico to receive the treatment and follow up visits to the Canadian or US doctor's offices. Even so, it's also worth a look see while you're doing your research on what treatment to go with.

Good luck!