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Old 07-27-2008, 03:20 PM   #1
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I Don't See A Lot Of Posts About Radiation Seed Therapy

I'd like some information on this for those who have had it done. Is it not a good choice? To many side effects?

 
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Old 07-27-2008, 04:14 PM   #2
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Re: I Don't See A Lot Of Posts About Radiation Seed Therapy

I recall looking into this briefly, but due to the larger size of my prostate I would have had to go through some hormone therapy to shrink its size before being eligible for seeds alone. I could have done a combo of IMRT and seeds, but the potential side effects caused me to dismiss this type of approach.

Hopefully you'll hear from someone that's been through it. There are some prior posts, so if you try a search, you'll get some of the info you're seeking.

 
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Old 07-27-2008, 04:25 PM   #3
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Re: I Don't See A Lot Of Posts About Radiation Seed Therapy

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Originally Posted by builder View Post
I'd like some information on this for those who have had it done. Is it not a good choice? To many side effects?
On the contrary, seed therapy appears to be an excellent choice for many men, as good as any other for the "typical" patient, but more suitable or desirable to some of us than to others. One advantage in considering this therapy is that it has an extensive, very-well documented track record.

I have not had this therapy for my high risk case, but early on in 2000 I considered it carefully as part of a possible seeds plus 3D-conformal external beam radiation approach. My impression is that seeds, or seeds in combination with IMRT (Intensity Modulated Radiation Therapy) is currently the most chosen therapy. One of the great appeals of seeds alone is the speed of the treatment and recovery period. However, there are usually some side effects, as there are with any therapy, with the seriousness varying among patients. Most patients with cases appropriate for seeds who are treated by experts appear to do very well.

I hope you will hear on this board from those of us who have had seeds, but there are some excellent books and other sources of information about it.

A book I particularly like is by the Dattoli team, which is located at the Dattoli Cancer Institute in Sarasota, Florida: Dr. Michael j. Dattoli, MD, Jennifer Cash ARNP, MS, OCN, Don Kaltenbach, “Surviving Prostate Cancer Without Surgery – The New Gold Standard Treatment That Can Save Your Life and Lifestyle – The Whole Story on Brachytherapy and IMRT from Doctor, Nurse, and Survivor,” 2005, Senaca House Press, Sarasota, $18.95 USA.

Dr. Dattoli is widely acknowledged as one of the world's experts in radiation therapy for prostate cancer, and he has written textbooks for doctors about it as well as his numerous information resources for patients. He has presented at a number of the National Conferences on Prostate Cancer and always speaks to packed halls.

Another widely acknowledged expert group is from the Seattle Prostate Cancer Institute, and three of the leaders have edited a book on prostate cancer, and in particular have contributed key chapters about seed therapy, for which they too have been pioneers. (By the way, one of them, I believe Dr. Blasko, co-authored a text on it with Dr. Dattoli.) The book: editors Dr. Peter D. Grimm, D.O., Dr. John C. Blasko, MD, and Dr. John E. Sylvester, MD, "The Prostate Cancer Treatment Book," (subtitle: "The Most Up-To-Date Information Available on Seed Implant Therapy"), 2004, McGraw-Hill, New York.

Another nationally leading group is the Radiation Clinics of Georgia, RCOG, located in Atlanta. They have information resources for patients, but I'm not aware that they have published a book. Like Dr. Dattoli, who often uses a combination of external radiation and seeds, RCOG uses a combination but implants the seeds first, then does IMRT, bouncing and scattering some radiation off the seeds in a precise way. Dr. Dattoli and RCOG have some sharp disagreements about whether external radiation should be first (Dattoli) or the seeds.

All these doctors and others have published impressive results in respected medical journals. When I was first diagnosed back in late 1999, seeds looked like a good approach but the medical world was hesitant because there were not enough years of follow-up for patients to give a persuasive picture of how well it was working, especially as compared with surgery. (That's like the situation for proton beam therapy today.) Now that has changed, and we have solid data with long-term follow-up showing that this is an excellent therapy for appropriate patients. Obviously, if used alone, it is not good enough for a patient whose prostate cancer has already spread or has probably spread beyond the range of the seeds. (Research from all three groups - Dattoli, Seattle, and RCOG - is described in the book "A Primer on Prostate Cancer - The Empowered Patient's Guide." ("Primer" for short.)

There are some restrictions on who can get seed therapy, such as the size of the prostate, but often doctors can work around this and other issues. A short course of hormonal blockade is often used to shrink the prostate, and some experts, like Dr. Dattoli, are able to treat prostates that are larger than can be treated by less expert doctors. Unlike RCOG (not sure about Seattle), Dr. Dattoli is highly experienced in using hormonal blockade not just to shrink the prostate but as part of the therapy for appropriate cases. There is good evidence that blockade makes it easier for radiation to eliminate prostate cancer stem cells, among several benefits.

By the way, for anyone looking at the possibility of proton therapy at Jacksonville in Florida, Dr. Dattoli's institute is maybe a half-day's drive away across the state and south in Sarasota. (There is a Hope Lodge type of place with inexpensive rates for those who have weeks of external beam IMRT treatment near his institute.) Anyone willing to tour Florida researching treatment options can visit an expert in another therapy, cryosurgery, Dr. Gary Onik, who practices in Celebration. (No idea where that is.) A leading DaVinci robotic surgeon, Dr. Krongrad, also practices in Florida, so there's another base to touch.

Dr. Dattoli is, of course in competition with the approach at RCOG, with cryosurgery, and with proton therapy, and he has given his view of each in comparison to his type of approach.

So often we focus on therapies that feel right to us and do not adequately look at how good a match we are for the particular therapy. The Dattoli book is excellent on that match, as is the Primer. Among other things, he describes the value of the PAP test (Prostatic Acid Phosphatase) as an aid to predicting whether seed therapy is likely to be effective for a patient. (His research is mentioned in the Primer, pages 52-53.)

Jim

 
Old 07-30-2008, 12:41 AM   #4
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Re: I Don't See A Lot Of Posts About Radiation Seed Therapy

If you search on this board for "brachytherapy" you will find a few posts about seeds - including a complete account (to date) of my case (seeds implanted 7th February 2008).
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Old 08-03-2008, 07:28 PM   #5
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Re: I Don't See A Lot Of Posts About Radiation Seed Therapy

I had brachy therapy exactly one year ago. My prostate size was 60cc. The doctor thought it was ok to to the brachy even tho my large size. Gleason score 6, psa 3.75. My psa has been dropping and 3months ago was 1.75. I thought this was the best option for me because i am 57 and my cancer was not aggressive. Also, i like that fact that Brachy has much better results that prostatectomy with regard to urinary incontinance and impotence. One year after brachy that is true in my case. My erections are as good as ever, and aside from occasional urgency symptoms i have no complaints at all.. More and more studies are showing that brachy can have as good long term results in cancer comeback as prostatectomy. So i would do it again. I had urinary irritation symptoms for about 5 months. But no leakage. Do lots of research, and make sure you understand the choices available with your gleason score and core sample percentages. Everyone is different.

 
Old 08-08-2008, 08:06 AM   #6
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Re: I Don't See A Lot Of Posts About Radiation Seed Therapy

I had brachy seed therapy in 2004, where 48 pilladium seeds were implanted. My PSA never zeroed and began to rise after 2 years it was determined that the rise was not the result of a "bounce" and a PSA over 11 we concluded that the brachy seed therapy had failed. Another biopsy confirmed that the Ca was still present. So, in April of 2007 I had prostate cryosurgery, PSA is very low (below .0.05 but doubling every 6 months). Could be the Ca is still present.
As far as side affects from brachy seed therapy. I remember increased urgency along with increased inability to go; sexual potency was affected, too; not too much pain involved with the procedure.
Hope this helps.

 
Old 09-06-2008, 06:46 PM   #7
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Re: I Don't See A Lot Of Posts About Radiation Seed Therapy

I just found the HealthBoards recently. It looks like a good place to share my experience.

I had IMRT radiation plus brachytherapy for prostate cancer in early 2003. My PSA was still below 4 but went up 0.5 in a year. My family doctor wisely took note and sent me for a biopsy which showed the cancer. My initial plan was to have the surgery, but the second surgeon I saw - who was vastly more experienced than the first - said I would be completely incontinent because of previous surgeries. He recommended the radiation treatments. I had Palladium seeds implanted because the second hospital read my biopsy slides and gave me a slightly higher Gleason score.

I had absolutely no side effects from either the external or internal radiation. My PSA went down every time and has stayed at or below 0.1.

I read and recommend Pat Walsh's Guide to Surviving Prostate Cancer. I sent a copy to each of the men in my family.

A few observations based on my experiences, some of which have been mentioned in other posts as well:

- DO have your PSA checked and do not ignore it if it starts to go up.

- Take time to read about the disease and the treatment options. Maybe the only blessing of the diagnosis is that you do have time to decide what is best for you.

- Everyone is different. Talk to other patients, but the best course of action for you depends on your own situation.

- Do get a second opinion, especially if you have any reservations at all about the first one.

- Stay positive. With an early diagnosis and the treatments available today, most men should be able to go on with their lives for many years.

 
Old 09-06-2008, 06:54 PM   #8
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Re: I Don't See A Lot Of Posts About Radiation Seed Therapy

Just wondering if you had any symptom prior to finding cancer? Was the digital examine normal? was the prostate tender or hurt when he pressed on it? Was there any urinary symptoms prior to bring diagnosed?

 
Old 09-06-2008, 07:09 PM   #9
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Re: I Don't See A Lot Of Posts About Radiation Seed Therapy

No symptoms at all. The previous year the PSA had also gone up, but the biopsy was clear.

 
Old 09-19-2008, 02:21 PM   #10
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Re: I Don't See A Lot Of Posts About Radiation Seed Therapy

Quote:
Originally Posted by damatoman View Post
I had brachy seed therapy in 2004, where 48 pilladium seeds were implanted. My PSA never zeroed and began to rise after 2 years it was determined that the rise was not the result of a "bounce" and a PSA over 11 we concluded that the brachy seed therapy had failed. Another biopsy confirmed that the Ca was still present. So, in April of 2007 I had prostate cryosurgery, PSA is very low (below .0.05 but doubling every 6 months). Could be the Ca is still present.
As far as side affects from brachy seed therapy. I remember increased urgency along with increased inability to go; sexual potency was affected, too; not too much pain involved with the procedure.
Hope this helps.
Hi, damatoman, I am trying to digest the relative advantages/disadvantages of brachytherapy and prostatectomy by reading literature. I have a urologist surgeon (who among other procedures can use the DaVinci robot) who has suggested a second opinion with an oncologist radiologist. My internal medicine doctor suggested I ask the radiologist about seed treatment. Like many others, I am looking for the procedure that has the best chance for survival. If you weighed these options, can you share the factors that resulted in the brachy seed decision? If the question does not relate to your situation, you don't need to reply. Good luck on your continued recovery. Dale

 
Old 09-25-2008, 10:49 AM   #11
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Re: I Don't See A Lot Of Posts About Radiation Seed Therapy

With prostate cancer a study to compare survival rates should follow up at least 15-20 years, and of course most current treatments have not been around that long. So you have to go with short term studies, PSAs, and some faith.

My opinion:
Surgery is the gold standard, particularly with the nerve sparing technique. It is important to go to a surgeon with lots of experience.

Traditional radiation - IMRT and brachytherapy, in some combination - is effective with fewer side effects.

The new methods - robotic surgery and proton therapy - have theoretical advantages but haven't been used long enough to establish a track record. That doesn't mean you shouldn't go with them if they are available to you.

I believe the survival rate is very good with all of these treatments; in fact, the five year rate isn't too bad with no treatment. Other factors to consider: availability, experience, insurance, side effects.

All this assumes you catch it while it is still confined to the prostate.

Last edited by kd66; 09-25-2008 at 10:54 AM. Reason: clarification

 
Old 09-25-2008, 11:24 AM   #12
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Re: I Don't See A Lot Of Posts About Radiation Seed Therapy

Quote:
Originally Posted by kd66 View Post
With prostate cancer a study to compare survival rates should follow up at least 15-20 years, and of course most current treatments have not been around that long. So you have to go with short term studies, PSAs, and some faith.
...
kd66 sums up the story concisely and compares the prominent alternatives as well as I've seen done. Guess that's the problem too. There are so many approaches and no one is distinctly better for all. One needs to study the various treatments and choose the one he feels most comfortable with. Doctors can obviously help lead to a choice, but many of us just need to do our own due diligence before selecting-- and not be pushed one way or the other just because a doctor says so.

 
Old 09-28-2008, 11:48 PM   #13
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Re: I Don't See A Lot Of Posts About Radiation Seed Therapy

I've just seen a press release from a German HIFU/Brachytherapy specialist claiming Brachytherapy is carried out 20% more than surgery for prostate cancer in the USA.

Any comments anyone?

If this is true, and there are so few brachytherapy posters here, perhaps it is an indication of how little effect brachytherapy has on lifestyle, meaning the support of these boards is not so vital?

The same press release also says there are 4 HIFU centres in Germany.
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Old 09-29-2008, 08:51 PM   #14
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Re: I Don't See A Lot Of Posts About Radiation Seed Therapy

[QUOTE=tumbleweed;3744556]I've just seen a press release from a German HIFU/Brachytherapy specialist claiming Brachytherapy is carried out 20% more than surgery for prostate cancer in the USA.
That's an interesting comment about brachy. I don't have numbers ready at hand but I've read figures showing that brachy is more popular in the US, and a 20% difference in its favor would not surprise me at all. I think it would be the clearly dominant choice now if it were not that robotic surgery has substantially reduced the side effect burden of surgery. We now have fairly long-term figures showing that modern radiation for prostate cancer competes well with the success of surgery, if apples are compared to apples Gleason-wise, PSA-wise, etc....

If this is true, and there are so few brachytherapy posters here, perhaps it is an indication of how little effect brachytherapy has on lifestyle, meaning the support of these boards is not so vital?

That could well be the case! In support groups, we get guys mostly who are either at the start of their journeys and need information, who are in long-term therapy situations (like me), or who are having problems with side effects, and posters on boards could be similar.

Also, it could partly be that brachy (without supportive IMRT, which takes many weeks) appeals in part because it is fast (one day, perhaps outpatient or one day hospital stay, with minimal post-treatment entanglements like the catheter for surgery) and the immediate side-effect profile is fairly low. In other words, many brachy patients want to be treated quickly and then get on with life and forget about prostate cancer as much as possible, meaning less presence on boards.

I suspect that a decade ago many patients hesitated to have brachy, despite its great convenience, because success figures were not available for many years after therapy. That started changing around 2000, something I was watching closely for myself. Now, for instance, Dr. Dattoli has recently published papers that include even intermediate and high-risk patients with impressive 13 and 14 year follow-up data. (Dr. Dattoli often prefers a combination of brachy and IMRT for such patients, so they are not in the quick in-and-out group.) One key point he has mentioned in several conferences is that the number of patients having recurrences flattens out fairly early in his series - I think around six years but am not looking at the figures, instead of continuing to gradually increase, as is typical for surgery.

It is truly a great development that we are now benefitting from major improvements in various therapies and that we have at least intermediate term results data that can give us confidence in well-performed therapies, such as surgery, seeds, IMRT, seeds/IMRT, cryo, and perhaps even primary hormonal blockade therapy.

Jim


... QUOTE]

Jim

 
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