Brachytherapy: To seed or not seed prostate cancer

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Brachytherapy or seed radiation is considered by many prostate cancer patients. Dr. Jing Zeng gives us an easy to understand discussion about brachytherapy for prostate cancer. Dr. Zeng is a board-certified radiation oncologist and Associate Professor of Radiation Oncology at the University of Washington School of Medicine. She specializes in treating genitourinary cancers (such as prostate cancer) and thoracic cancers. Dr. Zeng earned her medical degree at Duke University, completed her residency in radiation oncology at Johns Hopkins Hospital, and has been in Seattle since 2012. She currently serves as the Medical Director of the Seattle Cancer Care Alliance Proton Therapy Center, and is actively engaged in running clinical trials to improve cancer treatment.
Our interviewer is oncology social worker and Malecare's Director, Darryl Mitteldorf, LCSW.
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For more information about prostate cancer: malecare.org

[@danarussell4246]

I have to see the doctor tomorrow and make a treatment decision. I’m sure glad I found this video today. I sure wish this lady was the doctor I was going to see. Great information by both parties.

[@steveperks100]

What a reassuring voice. Love a consultation

[@lpplau]

The guy is very well educated and informed... Very detailed informational questions.. answers are very detailed and very educational. Thnx

[@jackbippus2757]

Great job young lady !

[@brianireland6527]

Talk to Dr. Scionti at his clinic in Sarasota……I’m heading there on the first of Feb. .Amazing doctor!

[@JimmyCornPop]

Thank you. This is definitely helpful in my decision as to which type of treatment I have to choose.

[@magnusson_dan]

Well performed, both of you. I did HDR brachytherapy 1,5 year ago. Gleason 9, small prostate. Two treatments, combined with 25 days of external x-ray. Modern equipment, all over. Started with hormon therapy 8-9 months before brachytherapy. PSA decreased from 28 to 1,6. After brachy and X-ray, unmeasurable for over a year. Still on hormon therapy for another year.

[@jerrymunroe5593]

Sounds like me. Just diagnosed with Gleason 9, My prostate has been somewhat enlarged. Next week I will have a Pasma Pet scan to see if it has spread. My urologist wants surgery (he is a surgeon). If it hasn't spread, I am thinking about this HDR brachytherapy, external xray and the doctor mentioned hormone therapy. I am of course worried about urinary and bowel problems. I guess my nightmare has begun.

[@timferguson593]

@@jerrymunroe5593you will be fine. Good treatment choice.

[@jerrygrudzinsky6425]

What a great young woman.

[@joellevy7885]

Had external beam radiation over a two week period, Gleason 4+3 , was successful and have had no side effects. PSA is undetectable 5 years later. Had it don’t at Memorial Sloan Kettering in manhattan

[@karlbriales2095]

What made you decide to go this route and where did you get it done? I’m a 3+4=7 but the notes read: The cancer is too small accurately assign a pattern of pattern 4. So my doctor sent my biopsy to a molecular test and probably recommend Active Surveillance. But if I have to make a decision I would probably go your route because Surgery is the last thing I want to do. I just turned 61 and have no (none) symptoms. Your feedback is really appreciated.🙏

[@joellevy7885]

@@karlbriales2095 I didn’t want surgery and I didn’t want the seeds as I didn’t like possible side effects ,and I did a lot of research, At my consult at Memorial Sloan Kettering the radiation oncologist was one of the reasons as he was great. It’s called “ MSK Precise” they also did “spaceoar” to protect the rectum, going on 5 years now with no signs of cancer and no side effects. Treatment was painless done in less then 2 weeks. I’m so happy I did it this way. Check out “MSK Precise”

[@pinotwinelover]

Once they develop and identify the genetic marker that make some people very susceptible to radiation problems. This field will be off the charts.

[@gumbycat5226]

The question I have is, what is the actual risk of incontinence, erection malfunction from brachytherapy compared to external beam radiation, starting from 100% functional beforehand. I have chosen to go with a combination of both because I have come across studies which indicate that the combination a) eliminates the risk of cancer surviving inside the prostate b) kills the cancer if it has spread to the nearby nodes, ducts etc. [I am Gleeson 9 but the PET-PSMA scan indicates that the cancer (7 lesions, prostate 3.2cm wide) has not yet spread. Of course, it cannot indicate with certainty that it hasn't spread.]

[@jerrymunroe5593]

I am just diagnosed Gleason 9 and will have PSMA pet scan to see if it has spread and if not am considering what you said. What a nightmare I am sure I will be going through ahead

[@toppie5700]

I was diagnosed with gleason 9 prostate cancer , I had Brachytherapy , hormone deprivation therapy for 24 months and 5 weeks of external beam radiation , my psa dropped from 10 and stayed at 0.02 for 36 months then climbed to 0.05 with a slight testerone increase and then down to 0.04 for the last two blood tests , the oncologist seems happy with this , lets hope it stays this way

[@user-io8ss3zd4s]

Gleason 9 prostate , does it mean you had a real large prostate hence the brachytherapy and hormone deprivation therapy.

[@joellevy7885]

Great results considered undetectable at that number

[@Brammy007a]

External Beam usually involves hormone suppression (begins prior to radiation and continues way after the radiation).... hormone suppression is a gentle term for chemical castration. This is often not mentioned when external beam therapy is discussed. The long term side effects of hormone suppression is much worse than the radiation.

[@robertmonroe3678]

Yes. Many leading centers now combine SBRT (or IMRT) with HDR Brachy. In cases where they once prescribed IMRT plus ADT.

[@iamric23]

Please elaborate about the side effects, you never offered a description.

[@lindaweston4172]

my husband has just finished hormone therapy the course was two years. Hot flushes, weight gain and man boobs.... but he is still with us.

[@pinotwinelover]

Everybody who's on adt typically it's metastasize so if you have localized prostate cancer rarely, do they ever put you on adt unless aggressive genetic markers

[@jerrymunroe5593]

@@pinotwinelover Is adt hormone therapy? I am trying to figure out all of these abbreviations

[@thomaslehmann5981]

Fantastic interview

[@Malecare]

We’re happy that our discussion is helpful for you

[@Mico77777]

Make sure to use doctors with experience. I had brachytherapy and IMRT from a military radiologist at Walter Reed. He had no experience but assured me that his training was top notch, and that he was the quarterback of his high school football team. He basically ended my life with the treatments. Two months after the brachy I felt really sick for about 4-5 days, like I have never felt before. I'm almost positive that it was seed radiation emitting into my body, from outside the prostate capsule. My prostate capsule was rated A+ by Dr. Alan Parton at Johns Hopkins. The military guy, Joel Skinner, and his no experience assistant clearly poked the needles too far through the capsule and caused the cancer to escape the capsule. PSA went from 8, up to 38, within a couple months. I would have gotten treated at Johns Hopkins but the military wouldn't pay for a procedure outside of the military system. My life has sucked ever since then.

[@lindaweston4172]

My husband had brachytherapy last year, it affected him big time, he also had radiotherapy before, his bladder and bowels have never been the same.....BUT the cancer has gone his last PSA reading was 0.01

[@jerrymunroe5593]

That is what I am worried about is urinary and bowel problems. I was just diagnosed and my nightmare has begun. Next week I have a PSMA pet scan to find out if my cancer has spread, If it has I have no idea what direction I can or will go,

[@pinotwinelover]

One other interesting story, the seeds can sometimes dislodge, so some seeds are on a fiber there was a gentleman that was hyper paranoid about radiation, and he bought a geiger counter, and somehow one of the seeds dislodged into his heart and he was picking up radioactivity. It did not damage him, but obviously he was freaking out.

[@AmericanWop]

How many MREM does the source put out in the High Radiation method? I hear nothing of this.

[@thomaslehmann5981]

Great video. Who would have guessed that WC Fields knew that much about PC?

[@ulysseswilliams9372]

Great info

[@Malecare]

Glad you found our talk to be helpful

[@jfc650]

Thanks you so much for the video. This is one of the best videos talking about Brachytherapy I even watched. I am a prostate cancer ( three gleason-7, one gleason-9, with extra-capsular extension). I am also a high-risk hypertrophic cardiomyopathy patient. Are there any extra things need to be taken consideration in the therapy process?

[@Malecare]

We are glad our conversation was helpful

[@zosimoballanca9691]

How does brachytherapy differ from ablation procedure?

[@tomjgrant]

can a HoLEP procedure be done after LDR Brachy?

[@iamric23]

Can a PMSA pet scan be overlayed onto the ultrasound in order to pin point the cancer areas? I had a MRI fusion targeted biopsy recently, and I was wondering why this was not mentioned about the PSMA pet scan replacing the MRI image.

[@vespatrixie2555]

I am not an expert , nor a dr, IMO it's pretty damn hard almost impossible to have a metal free radiation operating room to have a PMAS pet scan in real time. MRI can now be real time with brachytherapy. Because your prostate is not nailed to a particular spot due to bladder and colon. A little movement in prostate can make brachytherapy a little bit off the mark in putting a seed in the lesion. MRi guided brachytherapy along w PMAS pet scan have changed the staging for the different levels prostate cancer

[@manbearpig8691]

I think that this is right on the money. My PSMA PET was 2 weeks prior to my HDR treatment. Because of movement over that time, overlay wasn't an option. PSMA PET are extremely expensive and insurance will only pay for it sparingly.@@vespatrixie2555

[@tomslick2058]

Unfortunately many patients have a large prostate and Brachy therapy is not appropriate unless hormone therapy is done first.

[@Malecare]

Indeed. An unexpressed issue that disappoints many

[@vespatrixie2555]

Not a Dr or expert, there are some Brachytherapy Dr's that are actually tracing out the prostate enabling better seed placement. Combine this MRI real time guided brachytherapy seems to be pretty effective.

[@holy_trinity_GP_legends]

If a patient gets HDR or LDR brachytherapy do they also get post procedure external radiation IMRT or SBRT for a period after?

[@timpye6162]

Yes. That's what the oncologist told me and it put me off the idea, especially if ADT is also recommended

[@manbearpig8691]

I had Gleason 9. PSMA PET showed it was contained. Started with ADT and then HDR. Without HDR I would have needed 6 weeks of external beam. With the HDR I was able to get by with 3 weeks of external beam with a slightly higher Grey value. That might not work for everyone, but it seems to have worked for me. @@timpye6162

[@carladerenzy3674]

I had a marginally large prostate, am 61, PSA of 525, Gleason 7, cancer metastatic (ribs, shoulders, lower back)...this was 7 months ago... Went on Orgovyx (ADT) and Nubeqa (ADT) plus Lutetium (trial). PSA now 2.3, prostate shrunk, no weight gain, exercising daily, eating plant-based, etc., physically fit and working as often as ever. Ultimately, despite metastasis, would like to go off ADT's and substitute with something with less side effects or try higher level Melatonin, etc. Side ffectrs, for me, mostly mental (some depression, amplified emotions, anxiety). The question I have is there anything else that can keep T lower once one goes off ADT's? And would Brachy also take care of residuals cancers after Lutetium? Most of mine have been significantly erased or reduced, but Brachy sounds like an interesting option.

[@DCGreenZone]

The recent 1st patient treated with Cu67 achieved a PSA of zero.

[@reinaldorodriguez2761]

She has a brilliant IQ on the subject of seed inplant...

[@szkola-inwestowania-walen]

Not to.

[@jssilverton]

Why would you plan prostate brachytherapy more than once?