From: burglar_of_turds@yahoo.com sprang forth the following thought:

WHAT THE HELL IS HDR TREATMENT?

=======> stands for high dose rate (HDR) temporary brachytherapy.

here is an explanation between the two type of brachytherapy.



Dr. Kelly explains the benefits of Brachytherapy.

   HDR Prostate Brachytherapy
Prostate cancer is well suited to brachytherapy. The prostate gland is
located under the bladder and in front of the rectum, and it is
imperative that the radiation be focused in the prostate to avoid
serious side effects. The prostate gland is also close enough to the
skin that it can be easily accessed by brachytherapy needles.

There are two major methods of prostate brachytherapy, permanent seed
implantation and high dose rate (HDR) temporary brachytherapy. Permanent
seed implants involve injecting approximately 100 radioactive seeds into
the prostate gland. They give off their radiation at a low dose rate
over several weeks or months, and then the seeds remain in the prostate
gland permanently.

HDR temporary brachytherapy instead involves placing very tiny plastic
catheters into the prostate gland, and then giving a series of radiation
treatments through these catheters. The catheters are then easily pulled
out, and no radioactive material is left in the prostate gland. A
computer-controlled machine pushes a single highly radioactive iridium
seed into the catheters one by one. Because the computer can control how
long this single seed remains in each of the catheters, we are able to
control the radiation dose in different regions of the prostate. We can
give the tumor a higher dose, and we can ensure that the urine passage
(urethra) and rectum will receive a lower dose. This ability to modify
the dose after the needles are placed is one of the main advantages of
temporary brachytherapy over permanent seed implants.

CTCA in Tulsa center was the first to be do prostate permanent seed
implants in Oklahoma in 1995, and in January 1997 we began doing HDR
implants. We have come to believe that there are certain benefits of HDR
over permanent seeds.
Andy Grove (chairman of Intel) chose the HDR procedure after analyzing
all the available forms of treatment, including permanent seeds. He made
the analogy that this treatment was like a "smart bomb", whereas
permanent seeding was a more crude "carpet bombing" treatment. He wrote
about his experience in a Fortune magazine article in 1996.
What Does HDR Treatment Involve?

Our treatment frequently consists of a combination of three separate
therapies:
High-dose-rate temporary brachytherapy
Moderate dose external beam radiation
Short term hormonal therapy

This is a three-pronged attack against the cancer, also known as "triple
modality therapy". Sometimes we can omit the external radiation or
hormone therapy. You may wonder why we would even want to add external
beam radiation. Cancer cells may migrate outside the prostate gland,
known as "extra-prostatic extension". Treatments like the radical
prostatectomy and permanent seed implant alone may miss cancer cells
which have escaped outside the prostate into the surrounding tissues.
Another issue is that scans like the CT, MRI, ultrasound, and
Prostascint are far from perfect in their ability to detect cancer cell
spread outside the prostate. Even though these scans may not show cancer
spread beyond the prostate capsule, it can still be present. We use the
external beam radiation to target those areas surrounding the prostate
gland. The probability that cancer has spread beyond the prostate gland
can be estimated by the Partin tables.

The HDR procedure may differ at other hospitals. At CTCA, we insert 18-
25 catheters hollow plastic needles into the prostate gland. These are
placed using anesthetic, and rectal ultrasound guidance. After the
needles are placed, we perform a CT scan and we do a computer plan which
will calculate how long the radioactive source will stay in each needle.
Three times over the following 24 hours, the needles are hooked up to
the brachytherapy machine (HDR remote afterloader), and a treatment is
given. During those 24 hours the patient will remain in a hospital bed.

The external beam component is given in a moderate dose, 4500 centigray
divided over 4 - 5 weeks. This compares with the standard 7200 centigray
divided over 8 weeks which would be required if you were having external
beam radiation alone. We usually use intensity modulated radiation
therapy (IMRT) and daily ultrasound verification that the prostate is
centered in the radiation field (BAT). The reduced dose and precision
targeting of IMRT may result in a lower risk of side effects. Some
patients may receive broader radiation fields if there is a possibility
that their lymph nodes contain cancer.

We can also offer using HDR alone without any external beam radiation
for early prostate cancer. This is known as "HDR monotherapy". If HDR is
given without external beam, a higher dosage must be given, over 3 - 6
treatment fractions which may require two separate implants. There is
not as much experience or results using HDR alone as there is with using
HDR + external beam.

We also frequently recommend short term hormonal ablationtherapy which
we start 3 months before the brachytherapy, and continue for 3 - 12
months afterwards. The hormone therapy consists of a
once-every-three-month injection of Lupron or Zoladex, and an
antiandrogen medication like Casodex. The hormone therapy will shrink
the cancer, shrink the prostate gland, reduce the PSA, and hopefully
increase the cure rate from brachytherapy because there will be less
cancer cells for the brachytherapy to kill. Studies have shown that
adding hormonal therapy to radiation can increase the tumor control
rates, notably for Gleason 7 and higher or PSA 10 or higher. Patients
with a low-risk prostate cancer may be recommended to take a shorter
duration of hormone therapy, or none at all. Patients with high-risk
prostate cancer may be recommended to take triple hormone blockade for
approximately 15 months.

Who can have this treatment?

HDR brachytherapy program can be used for a wide range of prostate
stages, PSA values, and tumor grade. The components and dosages are
modified for those with low, intermediate, or high risk prostate cancer.
This treatment can also certainly be used for many tumors which are
considered too advanced for radical prostatectomy. As long as there is
no obvious spread to distant areas of the body like the bones this
treatment can be considered. For early stages, our treatment is an
alternative to the radical prostatectomy, but with less side effects.
Eligible patients include:
Any tumor stage (T1 - T3)
Almost any size prostate gland (large glands will require hormone
therapy prior to brachytherapy)
No known spread of cancer to other parts of the body, like the bones or
lymph nodes
Any PSA
Any Gleason
Previous trans-urethral resection of prostate (TURP / TUPR) is okay, but
there may be a higher chance of urinary control problems.
Reasonable health

Results

We have treated well over 600 patients with a wide range of stages. We
estimate that our 5 year cancer-free rate will be in the range of 90 -
95% or better for low-risk early prostate cancer patients. In patients
with an initial PSA less than 10, and a Gleason score of 6 or less,
nearly all our patients are currently free from cancer recurrence. The
majority of our cancer recurrences to date have been in the bones or
lymph glands in patients with high-risk prostate cancer. We have a
protocol in place for those patients with high-risk PCa (PSA > 20, or
Gleason >= 8, or stage T3) to try to improve results over what has been
achieved with other treatments in the past.

Our side effects have been very favorable. It is typical to have
urethral, bladder, and rectal irritation for a few months following the
HDR and external beam. However, we have had no cases of serious long
term rectal injury. Our incontinence rate is less than 2% for men who
have not had a TURP. The risk of developing impotency is estimated to be
approximately 30 - 40% for those treated with HDR plus external beam.
This is similar to other forms of radiation or brachytherapy, but better
than the risk with prostatectomy. If impotency develops, it can still
usually be helped with Viagra or other drugs or devices.

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc

From: jerry.holzer@sbcglobal.net (Jerry)
"c palmer" <PALMER_ENT@webtv.net> wrote in message
news:21537-43387F9B-164@storefull-3214.bay.webtv.net...
i called the local prostate cancer council to get information about
getting a psa test.
Check out: www.healthcheckusa.com
No doctor necessary.
Can also call 1-800-929-2044

============>  thanks jerry,  i made a copy of this and will give it to
my sons.

~ curtis  

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc