That website feels like its advertising hard.  Makes me leery.  I had a
consultation with California Pacific Medical Center today, where I heard
about the treatment.

I'm leery of radiation in general because it seems "dirty", i.e. gets in
too many unwanted places.

I'd like to see some long term numbers on recurrence, side-effects, etc.

Two others who've had HDR are myself and Clarence Crow from
Australia.  However neither of us had it as a monotherapy.

I had it in a clinical trial at the National Cancer Institute.
They were testing MRI image guidance of the seed placement.  The
technique worked pretty well (more about that in a minute) but
has been superseded by improved sonographic techniques which are
apparently much cheaper and simpler and equally effective.

I had 2 HDR brachytherapy sessions, with 25 intervening sessions
of 3DCRT for my Gleason 4+3 cancer.  All of the men in the trial
were "intermediate" risk (Gleason 7 or PSA 10-20) and for such
men, at least at the time when I had the therapy, any kind of
brachytherapy (low or high dose) was usually supplemented with
external beam to treat the area around the prostate.  The reason
for that is that, the higher your Gleason or PSA scores, the more
likely it is that some cancer is found outside the prostate
capsule, beyond the reach of the seeds.  Hence the external beam.

I also had two Lupron injections, covering 4+ months of
treatment.  The rad onc at NCI recommended against it but another
rad onc I consulted strongly recommended it and I found some
evidence that appeared to show that it improved the effectiveness
of treatment for men at intermediate or high risk.

As to the effectiveness ...

14 men entered the trial I was in.  When I last spoke to the NCI
folks, if I remember correctly, 13 of them (including myself)
have still had no recurrence after four years.  I believe four of
the 14, including me, had big PSA "bounces" after treatment.
Mine went up to 1.8.  Another fellow had his PSA go up to 2.4
(IIRC).  He did not wait to find out if it was a bounce or a
recurrence.  He went on ADT and left the trial.  NCI has not
heard from him and doesn't know what his outcome is.

So, so far at least, and certainly in my case, I'm happy with the
effectiveness - but I did not have it as monotherapy.

As to side effects ...

These included:

- Blood in the semen during treatment.  I don't know if that was
due to the HDR or the 3DCRT.

- Significant urinary blockage after the second HDR treatment.
When I woke up from the anaesthesia I was unable to urinate.  I
did not need to be catheterized, but did need to use Flomax for
about 5 months, starting at two pills a day and winding down
eventually to one every two days before getting off altogether.

- Tenderness in the perineum.  This lasted for a week or so.  It
did not cause me to stop driving or to stop working at my desk
job (computer programming), but did prompt me to use a doughnut
cushion.

For about 6-8 weeks after the second treatment I was up
frequently every night, sometimes 7 times per night, to dribble
out small amounts of urine.  That tapered off.  Eventuall I got
back to about where I was before treatment

I had other side effects that I think were due to the 3DCRT.

All of the effects have pretty much worn off.

I think my potency has been affected, but it's hard to tell.  It
was already in some decline and it doesn't get better as you get
older.  In any case I can still have sex though I have to work
harder at it than when I was young, and Viagra helps.

I don't know where you're located doof, but there are some
centers that do a great deal of HDR brachytherapy.  IIRC, there
is a big center in Georgia that was highly recommended.  There
are others.

Is HDR better than regular brachytherapy?  Who knows?  The stats
might be slightly better, but both treatments continue to
improve.  One upside is that the seeds are in and gone.  One
downside is that it's impossible to give an adequate dose in one
session without burning up the patient.  It has to be given in
two or three procedures (I had two.)

There _may_ be an advantage in that the seeds don't wander.  If
the surgeon placed them in exactly the right places, thats
exactly where they deposit their radiation.  I don't know if
that's a real advantage that shows up in long term outcomes, and
don't know if anyone knows.  I speculate that it is an advantage
for some patients and not for others - depending on how much and
how far their permanent seeds would have wandered.  Some rad oncs
actually check low dose seed placement some weeks after
treatment and add more if they wandered too much.  However my
sense is that that is uncommon.  Many don't even check.

In any case, if you are getting any brachytherapy, or any
radiation, or any surgery, or any treatment at all, you want the
best and most experienced people to do it.  Getting the seeds in
the right positions can be a matter of millimeters, or fractions
of millimeters.  The docs need tremendous knowledge (and first
class computer assistance) to know just what the best places are,
and great skill to get them there.  You need people who care, who
have done this many times, who are using top quality equipment,
and who have good staff to assist them.

For all of us with cancer, it's the first treatment that gives us
the very best shot at a cure.  Whether we have surgery,
radiation, or whatever, it's often not possible to repeat the
treatment.  So it has to be done right the first time.

Best of luck.

   Alan

Hi Cmdr.....I missed this earlier.

I wonder if the sudden soar in PSA isn't part of this.  Dr. Loblaw was
baffled, but then 2 other men did the same thing.  As he is also the
Director of Oncology Research, he was writing Ron and the other two up
in a paper.  But he said Ron's was the most *dramatic*.  Shot to 24+ in
2 months.  The other fellow went up to 20 but refused the hormone
therapy and it magically dropped to where it should have been.

At the moment after 2 years of being off the HT, Ron has crept from
undetectible to 0.37.  We will wait and see.  He has tons more energy.
Now if I could just do something about his *inability to hear MY
voice*......lol!!

Heather