Prostate Brachytherapy - Low dose rate or high dose rate: what you need to know - Dr. Juanita Crook

This video is a recording of Prostate Cancer Canada's October 2020 Nationwide Support Group meeting held over Zoom.
Dr. Juanita Crook is a radiation oncologist at the BC Cancer Agency, Sindi Ahulwalia Hawkins Centre for the Southern Interior, a pioneer in the field of brachytherapy research, and past Chair of the American Brachytherapy Society.
She is speaking here on Low Dose Rate and High Dose Rate Brachytherapy, including the pros and cons of each treatment, as well as the side effects.
For more information on Prostate Cancer Foundation Canada's (formerly Prostate Cancer Foundation BC) support groups, please visit: www.prostatecanada.ca
The views, information, and opinions expressed in this video are those of the individuals involved and do not necessarily reflect the official policy or position of Prostate Cancer Foundation Canada (PCFC) or its employees. PCFC is not responsible and does not verify for accuracy any of the information contained in the videos available for watching on this site. The primary purpose of these videos is to educate and inform, but these videos do not constitute, or replace, medical or other professional advice.

[@bartram33]

I’m going for my HDR brachi pre op in three days. This has given me so much more optimism for a cure for my Gleason 7 4.3 Thank you so much.

[@saam7408]

Amazing presentation. Many thanks for a comprehensive presentation on data for each modality but specially for detailed discussion on low and high dose radiation brachytherapy

[@jaktao6044]

Excellent presentation!

[@holy_trinity_GP_legends]

Thank you very much Dr Crook. Excellent presentation covering everything I was wondering about regarding HDR Brachy and subsequent recurrence rates.

[@brianwells6914]

Excellent presentation of current treatment options. Somewhat technical but worth the time to review .

[@cooperjdcox49]

I had HDR Brachytherapy three years ago. My last PSA was 1.7. What should I do? I was a Gleason 3/4=7 favorable PSA of 8 when treated. Your take would be helpful.

[@davidx8249]

Thank You, Dr. Juanita Crook. Enjoyed ur explanation of Brachy. I'll be getting treatment after four months of ADR, and decide to use HDR. The pin point placement sounds ideal, plus in my work as a technician I ride in golf carts alot. I'm concerned that permanent seeds will be bouncing around.

[@haroldcalderon9030]

Excellent explanation

[@johnpollock4257]

Excellent video 👍

[@janetw9430]

My husband has a 1.9 mm lesion, so why the whole prostate treatment and just the area of lesion. I hope they can just treat the area of the lesion only.

[@tomflynn2912]

Thank you

[@robgerety]

Thanks for this. I'm not sure how hormone therapy impacts these numbers. For example. I am 4+3 = 7 with a large tumor covering almost the entire gland. Some suspicion of disease in pelvic nodes but not definitive even after PSMA PET. I have had 3 of my 6 month course of hormone therapy (Lupron plus Darolutamide trial). My psa went from 17.0 to 0.06 ng/ml on test immediately before radiation started. The plan is for External beam radiation of about 9 weeks. Start with wide field to get pelvic nodes, prostate and seminal vesicles. Finish with more narrow field to get prostate only (as I understand it anyway). Brachytherapy is not in my plan. Not even presented to me. Its hard to imagine my psa going any lower after radiation???

[@threeftr3349]

My husband is 65, had a PSA of 4.7 (within normal limits for his age), but because it went up 2 points within 6 months of his last PSA, he had a biopsy. His Gleason score is 4+3=7, MRI, PSMA shown cancer only in the prostate. A 4K test showed it was less aggressive then what the Gleason score showed. He had one 6 month injection of Lupron. Weeks later, LDR brachytherapy, since the cancer was tiny he only had the minimum amount of 38 seed placements. Weeks after that, he's going to get 5 weeks of beam radiation therapy. The way the doctor explained it the radiation damages the DNA of all cells. First you knock cancer down with hormone therapy that starves the cancer cells from testosterone. Cancer cells weakness is repairing it's DNA, so it will begin to die off. Which can occur over several months, or longer. The normal cells that that has damage DNA from the radiation treatment, can eventually repair itself. The immune system will clean up the damaged dead cell debris left behind. After that it is active surveillance.

[@tomslick2058]

You do different then America. High psa goes straight to mri. Sometimes radiation is enough treatment. Key is yearly psa to catch it early. But like the way you explained Gleason 8 and above need that extra outside radiation. Never heard that high Gleason scores need extra treatment even with surgery. Which by the way most urologist push as the gold standard. They do have a newer type pet scan that supposedly picks up cancers that the old one does not. Don't know if that would change treatment protocol now.a doctor from Hopkins said Bracytheropy is not being trained much now because there's no money in it even though he said it's the best treatment for contained cancer. Wish you would have talked about potential side effects that can acure 5 years after seeding such as stricture and rectal irritation. But surgery seems barbaric to me along with the incontinence being more prevalent. Bottom line is targeted biopsys are needed as radiologist assessment can be wrong. High pirads can come back negative aprox 30 percent of the time.

[@donwilson7312]

Why was my comment removed ?

[@janetw9430]

Do they do PSMA test?

[@JohnGordon-j9j]

Google show me a picture of how you land during prostate seeds therapy in plant

[@marinaisabelramirez8098]

So it’s curative at 50% rate at 10 years

[@janetw9430]

It sounds like it never can be cured.

[@janetw9430]

After brachytherapy, how is their quality of life including sexual?

[@mikepatel7235]

Amazing presentation!