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Medical Forum / Diseases and Disorders / Prostate Cancer / October 2005HDR Prostate Brachytherapy
A friend of mine had this procedure done at Cancer Treatment Centers of America (http://www.brachytherapy.com/prost-brachy.html), with success. I wish I had done it. I had RRP 2.3 yrs ago at top center by supposedly top doctor(s). Severe incontinence, multiple procedures to try and get the anastomsis (where they hook up the bladder to the urethra after removal of the prostate) to stay open enough to allow the implant of an artificial sphincter, with lots of pain and disability even now. I could even end up having to wear an external bag (like a colostemy bag) to collect urine. The HDR procedure seems to be more sensible conceptually than incurring the risk of complications arising from removing the prostate. RP surgeons aren't likely to know enough about, or even advise patients to consider, things like HDR. It is a newer type of procedure. >A friend of mine had this procedure done at Cancer Treatment Centers of > America (http://www.brachytherapy.com/prost-brachy.html), with success. [quoted text clipped - 9 lines] > or even advise patients to consider, things like HDR. It is a newer > type of procedure. I had HDR brachytherapy. So far (crossing my fingers and knocking furiously on wood) I'm happy with it. If my cancer comes back I may wish I had chosen surgery. I chose radiation because, in reading all of the literature I could, it seemed that the incidence of nasty complications and side effects is lower than with surgery and the treatment outcome is about the same. I had come out of the only surgery I ever had, a knee arthroscopy, much worse than when I went in. So I was shy about surgery to begin with. Then I talked to a friend who had had RP and almost died from an embolism a week after the procedure. Finally, the surgeon my HMO sent me to just didn't inspire any confidence in me. However there is still considerable debate about whether radiation is as effective as surgery. Nasty side effects are possible with radiation as well as with surgery. Some radiation patients will get bladder or rectal cancer years later because of radiation damage. Some have chronic proctitis (pain in the a.s). Some become impotent. Some experience urinary difficulties. A few can experience incontinence though it's much rarer than with surgery. Some guys seem to sail through RP with no pain and few side effects and other guys get clobbered. I'm sure that part of the outcome is the skill of the surgeon, but part is probably just good or bad luck. It sounds like you got clobbered. I hope at least that your cancer is gone and that the side effects will abate over time. Good luck with it. Alan On October 29, Alan Meyer wrote, in pertinent part: (snip) > Some radiation patients will get bladder or rectal cancer > years later because of radiation damage. (snip) I'm a graduate of IMRT, post one year. I'd appreciate it if Alan would furnish some further info on this; perhaps peer-reviewed studies. Thanks. Regards, Steve J "Facts are stubborn things; and whatever may be our wishes, our inclination, or the dictates of our passions, they cannot alter the state of facts and evidence." --John Adams > On October 29, Alan Meyer wrote, in pertinent part: > [quoted text clipped - 9 lines] > I'd appreciate it if Alan would furnish some further info on this; perhaps peer-reviewed > studies. I specifically asked my first radiation oncologist if there was increased risk and she said no. But my current radiation oncologist told me I was at increased risk and, starting at five years after treatment, should have regular exams to catch any possible cancers early. Here's a report of a 2005 study of 30,552 patients receiving radiation between 1973 and 94. It claims a clear increased risk. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=15825064&query_hl=1 There are some countervailing opinions. Here's one claiming that, up to 10 years after radiation, there was no increased risk: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=9607337&query_hl=3 Here are two that claim there is a risk. Both say the risk is relatively small, but requires watching: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=10640974&query_hl=3 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=9316648&query_hl=3 All of these studies necessarily involve less advanced radiation techniques than those used today. I'm hoping that whatever carcinogenic effect radiation has, it has been reduced by modern techniques. IMRT and brachytherapy may both reduce the exposure of organs outside the prostate, though I believe that the proximity of those organs makes it impossible to completely avoid irradiating them. My oncologist performed a proctoscopy on me 1 year after the radiation and put it on the screen for me to see. I could see considerable radiation damage to the rectal wall near the prostate. Alan
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