Brachytherapy + IMRT Report

Hi All,

I’ve been lurker on this forum when my dad was diagnosed with Stage 1 prostate Cancer. Your experience has helped me so much. I feel it would only be fair for me to return the favor by reporting on his condition and progress to help other guys going through the same thing.

Basic Info:

Age: 77

General Heath: Active, healthy weight (5’2”, 118 lb prior to diagnosis) managing high blood pressure and hyponatremia, slightly enlarged prostate

Diet: Typical Asian diet of rice, protein consisting of fish and the occasional meat, and vegetable.

Cancer Diagnosis: Stage 1, Intermediate Risk, Gleason 7

Treatment Plan: Brachytherapy followed by external beam radiation

Current Status: Brachytherapy seed implant done, finished day 4 of 28 for external beam radiation sessions. Symptoms are mild and manageable although he had to wear a catheter for a week post-brachytherapy. 

Details:

From about 2017, my dad’s primary care physician started to notice an increase in his PSA level. It started at 4, then increased to 7 by 2018. In early 2019, the PCP noticed it going to 10 so he referred my dad to Dr. James Hwong here in San Jose. Dr. Hwong did a digital rectal exam and found nothing of interest. He then gave my dad a course of antibiotics to rule out the chance of it being an infection. After the antibiotic, the PSA increased to 11 so Dr. Hwong did a biopsy. 12 cores were taken and 3 of the cores were cancerous. Of the three, 1 had approximately 60% of the tissues being cancerous while the other two had less than 10%. I believe this to be localized and not spread beyond that area.

Dr. Hwong, being a surgeon, gave us two options: Surgery while trying to save the nerve or he can refer my dad to Dr. Nurani if my dad chose to go for radiation. After going over the pros and cons, my dad chose radiation and got a referral to Dr. Nurani. As an aside, the reason why my dad chose radiation is because of the 10% risk of permanent incontinent given to him. That, to him, would be super annoying. Also, we have a few neighbors who had radiation done successfully. One gentleman had it spreading to his bones and he’s still surviving without any issues 10 years on. This was good enough for my dad to roll the dice with radiation.

Upon meeting up with Dr. Nurani, he gave us two course of treatment and the pros and cons for both. First course of treatment is brachytherapy + external beam radiation. This was the most effective (90% cure rate) but the urinary symptoms would also be more severe. The other option is hormone injection and external beam radiation only. The symptoms would be less severe but a cure rate of only 85%. My dad chose the brachytherapy + external beam radiation.

On Jan 10, 2020, he got the radiation seeds implanted as well as the fudicial markers implanted. I was told it was to help target the external radiation once the time came. He was not able to pass urine right after the procedure so they had to give him a catheter. That night, there was a blood clot in the catheter so we had to rush him to the ER to get it flushed. 5 days later, after the catheter was removed, he was still not able to pass urine that evening so once again, another catheter had to be placed. However, a week later when the 2^ndcatheter was removed, he was urinating fine, albeit more frequently. Last week, he had an MRI done for them to merge the image with the CT scan to begin the external radiation.

Symptoms encountered: During the brachytherapy portion of the treatment (5 weeks), he felt a general sense of fatigue and overall laziness. In his own estimation, he feels about 30% weaker than when he was at his optimal health. Prior to treatment, the running joke is that he’ll outlive me because he rarely gets sick and is very active and I’m only 33. For someone who has been energetic and doesn’t get ill often, the fatigue was something he had a problem adjusting to mentally but after 2 weeks, he had a routine going and was pretty chill. The other symptom was that he has 2 bowel movements in the early hours of the morning instead of the usual 1 at 6AM per usual. Finally, he feels some minor pain at the tip of his penis and is getting up to urinate more frequently, up to 5-6 times per night. 

Emotionally, all of these symptoms are mild and bearable because he survived getting shot in the arm by a North Vietnamese sniper and 6.5 years in a commie POW camp. To him, if this is the worst of it then it’s all good. Having faith in God and praying daily helps keep him centered as well. My mom and I would maintain normal activities although I’m driving him to the daily radiation treatment (M-F) just to be safe. Lots of crazy drivers here in the Bay Area and I don’t want his weakness and possibly decreased reaction time to be an accident risk. 

He’s finished his 4^th external beam radiation session and the radiation oncologists says all of his symptoms are by the book. His current symptoms have peaked in terms of their severity and should improve once the radiation treatment is completed. 

I’ll keep the community updated with progress but we’re super thankful that the radiation has gone so well up to this point. Cheers!