My journey, to date

By ptrombetta

2 min read

Here is my story. At the end, I will have a specific question for the group from those who have chosen HDR Brachytherapy.

Prostate cancer story

I'm 76 years old. For many years, PSA tested from 4.8 to 5.2. About 18 months ago I tested 9.x then a month later 13.6.

Years past I had done 2 random biopsies and they were negative so I was not worrying about the PSA and since I also had BPH, I assumed that my PSA was "my" normal around 5.

When the PSA jumped up to 13.6, I went on red alert. I went to a world class hospital in Bangkok Thailand and they did the F18 Multiparametric 3T MRI. The cancer was quickly found and a guided biopsy was done. Result was a Gleason 3+4 tumor with no cancer found elsewhere in the prostate from the random biopsy samples taken at the same time.

After much research, including watching many videos from PCRI, I decided on HDR Brachytherapy. I called Dr. Samadi in New York (very good surgeon) and he also recommended I do the Brachy.

I proceeded to do a Bone Scan and also the PSMA Pet/CT scan. There was no clear indication that the cancer had spread and that solidified my choice for HDR Brachy.

Prostate cancer question

I went to UCLA in Los Angeles and had them perform the treatment. They did the treatment twice... and here is my main question.... they did the treatment on two consecutive days. I stayed overnight with the 11 catheters inserted and had to stay still until the following morning, when they repeated the radiation.

Has anyone ever had a treatment like this? Everything I can see online indicates that the two treatments are usually one of two weeks apart.

I know that many different hospitals will have many different protocols. For example, my Thailand hospital will always give external beam in combination with Brachy as their protocol. Other hospitals always give hormones no matter what. In my case, 2 consecutive days and no hormones and I was done.

In the year since my Brachy, my PSA dropped to around 5.xx, then 2.xx and I'm at 2.2 right now. I was told that it may take up to 2 years to reach "nadir", and I should keep monitoring and if it starts to rise again, we would do more tests to see what is going on.

I should mention that one year before my Brachytherapy, I had a complete urine blockage. I underwent something called THULEP (Thulium Laser Encapsulation of the Prostate). I think similar to TURP but with laser vaporizing the prostate tissue.

Any comments from the group would be greatly appreciated.

Paul

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Busta35 Member
Hi Paul, I had HDR brackytherapy as a mono treatment 10 months ago, June 23. It was two operations performed a week apart. My PSA was 8.9 post op and 2.5 at nadir, a month ago, now spiked up to 3.4 this month. Having looked at the forums of men who’ve had LDR, and their subsequent PSA levels I’m starting to panic in honesty, for a number of reasons. Primarily I didn’t appreciate, wasn’t informed, that HDR is a very new procedure in the UK. I’d be very grateful if anyone who’s had HDR Bracky (not LDR) could share their PSA timeline results. Thank you 
1. Busta35 Member
 <inline-mention username="ptrombetta" user-id="8542220"/> Hi Ptrombetta, I was under that impression too, but now believe that’s not correct. Have a look at the report below. Its a 2018 Germany study that concludes exactly the findings of Harvard and University Hospital in British Columbia recent studies -(2022 study). HDR Bracky has excellent outcomes if your PSA at the 18 month mark is sub 0.5, British Columbia are stating 0.14 nadir is the target for definition of cure for Brackytherapy. Mine will be nowhere near that, meaning reoccurrence likely. Most of the data is from LDR Seed Brackytherapy but as I understand it the two treatments require the same outcomes for long term cure. 
2. ptrombetta Member
 <inline-mention username="Busta35" user-id="8880545"/> That's certainly interesting. Salvage therapies are improving for we Brachy folks, and that's a comforting thought. I have been following all of the excellent info at PCRI (Prostate Cancer Research Institute). Hundreds of short videos in laymen's language. You may want to follow them and get another opinion. You can even ask specific questions online and they will call you back with info that you need. I thought that was a great service.
Busta35 Member
Many thanks for the reply, much appreciated. I haven’t found anyone in the uk to compare notes with on HDR. I’m very pleased and reassured to hear your treatment has been successful to date. My error on the nadir, I should have said lowest test result to date. I’m concerned my PSA seems to be rising but early days. Your advice is reassuring and much appreciated as my spike was also around the 9 month mark. My consultant is keen to give me just one last test at the 12 months, not happy and will take issue with this. Many thanks again, I’d be very interested & grateful to hear about your future test results if have the time. Many thanks again, Best Regards Gary <inline-mention username="ptrombetta" user-id="8542220"/>
Richard Faust Community Admin
Hi <inline-mention username="Busta35" user-id="8880545"/> and <inline-mention username="ptrombetta" user-id="8542220"/>. I can't personally speak to HDR brachytherapy, but I did find this study which concludes that "The present results suggest that the PSA nadir level within 18 months after radiotherapy may serve as an early parameter for long-term biochemical control according to ASTRO definitions following radical dose escalation by HDR-BT for prostate cancer. Excellent outcomes were associated with nPSA18 < 0.5 ng/mL: <a href='https://www.sciencedirect.com/science/article/abs/pii/S1538472118304355' target='_blank' rel='noopener noreferrer ugc'>https://www.sciencedirect.com/science/article/abs/pii/S1538472118304355</a>. Hope this information is helpful and that others will chime in with their experiences. Best, Richard (ProstateCancer.net Team)

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