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Medical Forum / Diseases and Disorders / Prostate Cancer / January 2004Well cooked and free
I finished my last EBRT treatment yesterday morning. I've been thoroughly cooked from the inside by HDR brachytherapy and from the outside by EBRT - and have the hemorrhoids to prove it. The total treatment experience was a little worse than I could have hoped for, but a whole lot better than I feared. The truth is that radiation or surgery both do violence to the body and there are some negative effects. For anyone who wants to hear what it was like from someone who had been there and done that, here's a brief summary of my experience. The ill effects have been: Tenderness where I sit after the brachytherapies (there were two of them). Exacerbation of hemorrhoids that I already had. Pain and bloody semen during sex. Difficulty urinating (only after the second HDR, but still lasting.) I'm told this will continue for up to one month. Of course everybody's experience is different. Your mileage may vary. Compared to my understanding of radical prostatectomy, I think it was probably easier. For example: Missed no work except for actual treatment times plus one extra day after each brachytherapy. No pain from radiation except the tenderness and hemorrhoids, and some pain during sex. No Foley bag except during the HDRs themselves, withdrawn immediately after the procedures. No incontinence. No impotence (but a lot of loss of libido from the Lupron - which should wear off soon.) However radiation induced impotence may not show up for a long time after actual treatment. Less danger of infection, blood clot, and other complications. The disadvantages compared to RP include: No removal of the prostate for examination, no further categorization of the disease, no peek at the "margins". No immediate indicators of success via PSA. Treatment is prolonged. In my case it was about 6 weeks of actual radiation. Adding in the time for the Lupron, extends the total to about 4 months or so, depending on when it really wears off. As to whether radiation is as effective as surgery, well there's lots of dispute about that. I have accepted the theory that it is. Some people do not. Alan > I finished my last EBRT treatment yesterday morning. I've > been thoroughly cooked from the inside by HDR brachytherapy [quoted text clipped - 66 lines] > > Alan Good info. Looks like I am heading down the same treatment road so it's good to know what to expect. The only different is that I will have the 5 weeks of IMRT before I get the seeds. My Dr says that getting radiation after the seeds can sometimes cause damage to adjacent organs such as bladder. Guess we'll see. I'm only a month into HT so won't start radiation until the end of March. Age - 67 8/12/02 - PSA 3.7 10/13/03 - PSA 4.69 11/11/03 - PSA 4.8 11/18/03 - Biopsy - 10 cores one core-25% of core-Gleason 4+4=8 all other cores benign tissue 12/10/03 - Consult - Oncologist 12/16/03 - Consult - Radiation Oncologist Treatment Plan - HT - started 12/17/03 - Eulixen & Lupron Radiation - IMRT to begin 3/14/04 - for 5 wweks Theraseed implant after Radiation completed It looks like the main difference between what I did and what you are doing is that you are getting one long term implant of low dose radiation while I got two short term implants of high dose radiation (HDR). In HDR, they implant highly radioactive isotopes for a very short period (about 15 minutes) and withdraw them again. In the seed implant you are going to get they'll put low radioactivity isotopes in permanently - with actual treatment lasting about 16 months, after which the isotopes are only producing about 1% of the radiation they had when they started (half life of iodine 125 = about 60 days.) I've been told by the radiologists that the outcomes for the two types of treatment should be about the same. Mine was more punishing because it involved two procedures - with the attendant anaesthesia, puncturing of the skin to insert the treatment catheters, etc. Yours has the possible disadvantage of making you radioactive for a while. Don't hold grandchildren on your lap for the first couple of months, don't put film cans in your pants pocket, etc. On the whole, it sounds like what your doctors have prescribed is very well understood, well documented to be effective, and should be easy to tolerate. Best of luck with it. Alan > > I finished my last EBRT treatment yesterday morning. I've > > been thoroughly cooked from the inside by HDR brachytherapy [quoted text clipped - 85 lines] > Radiation - IMRT to begin 3/14/04 - for 5 wweks > Theraseed implant after Radiation completed Holding children is a myth! If you feel better not holding them - then don't. But you can slap a radiation badge on your fly and you won't see enough radiation to do anything. Bev > It looks like the main difference between what I did and what > you are doing is that you are getting one long term implant of [quoted text clipped - 116 lines] > > Radiation - IMRT to begin 3/14/04 - for 5 wweks > > Theraseed implant after Radiation completed Glad to hear your treatments are over and done with, Alan! Thanks for sharing! Now... time to get on with the rest of your life! ;) MikeH > I finished my last EBRT treatment yesterday morning. I've > been thoroughly cooked from the inside by HDR brachytherapy [quoted text clipped - 66 lines] > > Alan Hi Alan....... Glad to hear it is over and all is well, relatively. FWIW, Ron's experience with HDR and 25 EBRT was problem-free and other than fatigue, he really didn't have any significant side effects. It all seems like a bad dream now, but he was back to 'normal' energy-wise within 4 weeks. Only lasting effect (and we were warned of this), is that the bladder is not as 'expandible' and he doesn't try to wait too long. But no getting up at night to go.......unless the 17 lb. Wonder Cat leaps on his stomach and wakes him up......grin!! Even the doctors were delighted.....not just us. His main difference was he didn't have the hormone treatment like you did. He was a bit tender after the two long days in the OR for the HDR treatments, but he expected that. Our verdict? It was the best choice as far as we are concerned. But each person must decide for themself as to what is their 'best choice'. He had a major drop in PSA afterwards (10+ down to 3.5).....next one is Feb. 5th. We just booked a 3 week trip to Scotland and England for early June and at 71, you could say he had a 'wake up call'......we are going to spend our daughter's inheritance (at her command, lol). All I can say is that he feels great, looks great and is really enjoying life. And isn't that what the end goal should be? We refuse to worry about PSA's and all that stuff......we have a lot of living to do!! (G) And I want to especially thank all of you for being there for us when we got the devastating news!! You made it so much easier to deal with. And my mission in life now is to talk to my male friends and make sure they get checked. A few of them look a tad uncomfortable at first, but one of my good buddies is now being treated for BPH.....he had been putting off going to the doctors. Same age as Ron, but better Dx. I notice one thing that is different up here in the Great White North.....more men choose radiation than surgery. And of course, all of our medical care is free.......and our prescriptions only cost $4.00. So work on that Government of yours to get the same thing!! To the man that just found out he has to have a bone & CT scan.....that is standard up here. We had to wait for Ron's due to SARS, but they were both negative. So don't worry about it. I still keep reading the n.g. to make sure you guys are behaving, grin. And I will let you know how Ron makes out with his next PSA. All the best.......Ron and Heather. > The ill effects have been: > [quoted text clipped - 52 lines] > > Alan ... > All I can say is that he feels great, looks great and is really enjoying > life. And isn't that what the end goal should be? We refuse to worry > about PSA's and all that stuff......we have a lot of living to do!! (G) ... Hello Heather, Your attitude towards PSA is probably the right one. My understanding is that radiation often causes short-term PSA ups and downs. The problem is that prostate tissue, when under stress, produces PSA. After radiation a man still has a prostate, it's still partially functional and, for some period after radiation, is still under a lot of stress as the healthy cells try to recover from the radiation damage - putting out a lot of PSA as they do. I have heard stories that it can take 12-18 months after radiation for the PSA to settle down to a nadir value. Interestingly, the _effective_ dose of radiation applied with HDR is significantly higher than with EBRT. I got 46 Grays of EBRT + 21 Grays of HDR. But from what I've read, the HDR values should be multiplied by 2.5 or more to see what the equivalent EBRT dose would be. Using 2.5, my effective dose was 98.5 Grays total, much higher than the recommended 74+ Grays for EBRT. That's why HDR is considered to be highly effective. Best of luck to you and Ron. Enjoy your vacation and, someday in the next year or so, we hope to hear a low PSA report. Regards, Alan |
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