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Brachytherapy + IMRT Report

Posts: 3
Joined: Feb 2020

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. 



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 2ndcatheter 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 4th 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!

VascodaGama's picture
Posts: 3371
Joined: Nov 2010


Thanks for reporting about your dad's story. I hope the treatment achieves the expected results and that he recuperates well. Typically it takes about three months to be back to normalcy. I was impressed with his diet as I also share Asian dishes along my traditional Mediterranean style but I like it with rice noodles. A combination of fish, vegetables and fruits are my preferred meals.

No matter if you are a male or female, you know that you have 4 folds in risk for contracting prostate cancer or breast cancer due to your dad's case. You need to be vigilant starting with PSA and/or genetic screenings at the age of 38 years old.

Please let us know the detailds as the treatment advances.

Best wishes and good luck.


Posts: 3
Joined: Feb 2020

Hello All, 

Just an update on my dad's treatment (Brachytherapy + IMRT). He completed his daily external beam radiation this week and is pretty much back to his normal self. Some interesting observations:

- Symptoms of radiation side effects improved greatly once the IMRT was started. I do believe we're lucky in that his body was able to handle the radiation. We also think that the brunt of the problems were from the Brachytherapy whereas the IMRT was a breeze.

- His urinary issues is back to the old normal (getting up 3x a night to urinate). The pain, blood clots, etc from the brachythereapy stopped a few days into the beginning of the external beam radiation. 

- Physically, he's also back to normal. His stregth is indistinguishable from before the treatment. 

Final thoughts/Future:

We still have to schedule follow-up visit to the radiation oncologists and the urologist. Unfortunately, with the current Pandemic, going outside is more like dodging bullets so we'll get guidance from the docs if we can delay follow-up visits. This whole experience has really brought my family together and while it was challenging at the beginning, after a couple of weeks, we got into the routine. To be perfectly honest, the Coronavirus lockdown here in the SF Bay Area is more of a monkey wrench in our family's routine than the cancer. If you're at a Stage 1 and Gleason 7 or less, I think what my dad when through, on the grand scheme of it all, was not bad. Heaven forbids I get prostate cancer when I get older but of all the things that can kill me, this experience has really alievated our fear of prostate cancer. Only time will tell but we're hopeful and we'll keep praying. Good luck guys. 

Posts: 301
Joined: Dec 2017

Dr James hwong ..San Jose ..I looked him up ..3-5 years experience ..said he could do surgery after radiation and brachytherapy...hmmm ..surgery after radiation is extremely dangerous with major side effects .only few surgeons in the country will attempt this ,,I know this because a chose radiation as well big mistake being only 57 at the time ,but of course I saw a cocky well known surgeon with 32 year# experience and over 5000 surguries.he told me  that surgery could be done after radiation he said we do it here at UCSF but he didn't say he was the only one who does it ..but did say in a round about way that they don't go right to surgery if there is a  reoccurance ..also he is now a young 67 so if I get a reoccurrsnce I'm probably screwed Because he will be retired ..I can't believe dr with only 3-5 years experience would try to attempt that .I was hoping thst maybe you may had lead me to a great surgeon  .personally I think with 5 years experience I would not let that Dr do a simple prostatectomy yet alone a salvage ..but thanks for updating it gives some hope 

Posts: 3
Joined: Feb 2020

All, my dad's first PSA test after the treatment is 0.3. We were floored and are so happy with the result. He has no other issues and physically feels 100%. This PSA results is another psychological win for him and my family. 

Steve1961, Dr. James Hwong looks super young, most likely still in his 30s. I believe the older one is probably his father. I can't really comment on his skils as we chose the radition method. When we consulted with him initially, he made it seemed like surgery after radiation is also very iffy but we based our decision on future quality of life and since Dr. Hwong gave us the same survival probability for both surgery and radiation, chose radiation for the initial treatment. 

I'll keep everyone posted if my dad's situation change but hopefully, no news is good news. 

hopeful and opt...
Posts: 2331
Joined: Apr 2009


Great news, 0.3......please be aware that in the 18 to 24 month period after radiation, there is generally PSA  bump, so don't be alarmed at that time.

I also pee a lot at night. My urologist wrote a script for Alfuzosin hcl er 10 mg tablet which I take with my evening meal. There is a good chance that your father will pee less at night with this drug. ...By the way, with radiation, the prostate from atrophy shinks in size over time, which I believe will reduce the amount of times that your father pees at night.....I'm not a doc, so best to double check with his radiation oncologist.



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