Low Dose Radiation Seed Implants - Brachytherapy... My Journey

Cancer
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I posted my beginning story last week as being diagnosed in October of 2015. Low Risk, early stage, PSA of 6.2, Gleason score of 3+3=6. No symptoms relating to prostate cancer or prostate problems. After the biopsy, I developed prostatitis which was not fun and very uncomfortable - I took anitbiotics for several weeks and finally got better. At that point, my PSA went down to 2.0. Still knowing that I had the cancer was a worry to me in itself. At that poing, my urologist told that I could do the watchful waiting, or the active Surveillance, but knowing the cancer is there and could get worse, even though the doc said it was a slow growing kind - if and when I would need some kind of treatment,  I would be older and that it might be harder to deal with at that time. My overall health is good, I am 65 years old and fairly physically active. I don't run marathons, but I keep busy.  I did lots of reseach online about the various treatment options for low to intermediate risk prostate cancer. There are lots of websites for researching this topic. My urologist pointed me to one in particular that gave statistics on success rates etc on various treatment options. I narrowed my options down to (1) seed implants (Brachytherapy) and (2) Cyberknife for prostate cancer. My urologist was and is an advocate for the seed implants. He said that treatment has a very good success rate and has been around for a good number of years. He also told me that what ever treatment option one would choose, make sure it is one that has been used successfully many times. And also the doctor you choose should have performed the procedure numerous times. I met with the radiation oncologist doc to discuss all options available for my situation. He explained the pros and cons of each type of treatment - and he performed all of them. A lot is based on your own situation and what stage you have. I could have choosen from 3 treatments. (1) Traditional radiation - which would have been daily treatments from 4 to 9 weeks, (2) Cyberknife - which sounded like a good option: a beginning session where 4 gold markers are implanted into the prostate. A week or so later, the first of 5 radiation treatments begin. The markers help focus the radiation beam to the area needed which helps reduce the surrounding areas from large doses of radation... which is important. The less radiation to the surrounding areas is the best. That way you minimize the chances of unpleasant side effects. And all treatment options have their side effects. (3) The seed implants or Branchytherapy which is basically a one time treatment. Although there is something called a volume study before any treatment. That is where the radiation doctor uses an instrument much like the one used by the urologist who did the biopsy. This time though, no core samples taken... just a sonogram of the prostate to get precise dimensions, shape and overall size of your prostate. Uncomfortable, but not painful at all. From what I was told, if the prostate is too large, it has to be reduced in size to allow for the seed implants if that is your treatment plan. They can shrink the prostate with a hormone injection if necessary for seed implants. So I opted for the seed implants - which was recommended for my situation by both my urologist and the radiation oncologist. So I had the volume study done two weeks ago. Fortunately, my prostate was in the right size frame without a hormone shot. So the instructions for me were as such: I had to go from the doc's office to the hospital down the street from him to get a pre-op exam. This is also where the procedure would take place. They did a chest x-ray, took several viles of blood, and did an EKG - and of course asked many questions pertaining to my overall health. My seed implant procedure was then scheduled for Wednesday, February 24 (yesterday). One week prior to the procedure, I was to begin taking Flomax to help with urination. Honestly, I had no problem with urinating, nor frequent trips to the bathroom at night which seems to be a common problem with many men and doesn't necessarily mean prostate cancer.  My urologist explained to me why he wanted me to start taking the Flomax. He said that after the procedure, the prostate would swell a bit and this was really a precaution and to help keep me peeing well. And if you think about it, that is a good idea. I hate taking additional drugs, but this sounded like a good plan. He said that after a few months - that I may be able to stop taking it all together. So I hope that is the case. As those past few days had slowly gone by, my anxiety level increased. I dreaded the day, but I was anxious to get it done. I read lots of stories online from people who experienced the Brachytherapy... many of those stories were several years old. Most were good success stories, a few where not great, but not awful. So I decided to just quit reading about it... and think about other things... things I wanted to do when this whole thing was behind me. So yesterday morning, I had to wake up at 4:00 a.m. to give myself a Fleet enema... I had to be at the hospital at 6:00, and the procedure was schedule for 8:30. I arrived at the hospital and checked in. I was weighed, and had my blood pressure taken... I'm surprised that it was not sky high - but by that time I guess I was just wanting it to be over. I went into pre-op where the nurses hooked me up with an I V. My radiation oncology doctor came in to great me... and this man is really really nice. Very personable. He reasured me that all would be fine. Then my urologist came in to see me. He also was in high spirits and joked with me a bit. He said that they had scheduled 4 seed implant procedures that morning and that I had been schedule as the 2nd. But the first guy went to the wrong place - so I got bumped up to the number one spot. I then met with the anethesiologist who also asked many questions and looked over my pre-op results. He said all looked good and he didn't see anything of concern. He basically explained what he would be doing. First injecting a solution of Versed, a drug that would make me feel like I had had a couple of Margaritas. Which it did. Then he would inject an antibiotic, and then when we got to the operating room, he would give me something that would just put me out. He said I would feel nothinig and know nothing. He said it would feel like only a couple of minutes later, and I would be waking up. And that was all true. I had a catheter that was removed shortly after I awoke. I did have a feeling of needing to urinate. And I was given a plastic bottle for that purpose. I was able to pee a little - and it really burned... which the nurse said was normal. They wanted me to pee a few more times while I recovered from the anesthesia... each time it felt like I was peeing battery acid...  then the nurse wanted me to walk to the bathroom to pee the next time to make sure I was getting over the anesthesia. After about an hour or so, I was released from the hospital by 11:30 and I was home by noon. It is hard to sit let me tell you and the ride home from the hospital was not pleasant - watch out for the bumps in the road. And you do feel some pain... not intense, but you sort of feel like you've been kicked right between your legs - at the perenium which is where they insert the needles to do the seed implants. And you have a feeling that perhaps you may have a tennis ball up your behind. My urologist told me just to take ibuprofin for discomfort... so when I got home, I took 2 ibuprofin tablets... and within a couple of hours, I was feeling very little discomfort. But laying down is good. I could not sit comfortably, but i did manage to sit sideways to have dinner. The burning urination got better with each time I had to go. I was surprised that I didn't have the urgent frequent urination that I read about from some people. Although I couldn't walk very fast, so by the time I got to the toilet, I really had to go. I took another dose of ibuprofin at dinner time. I held the sofa down during the evening and watched some television and read. Another dose of iburofin at bedtime. I slept well and woke up around 6:00 a.m. to furinate. All okay with that too. This morning, another dose of ibuprfin with breakfast. I was also given a 5 day regemin of antibiotic as precaution. I am taking it east today, lounging around... catching up on emails and writing this post - but nothing extrme as I do feel a bit out of sorts. Still sore, but not as bad as yesterday. Sitting on a very soft cushion helps. My exercise today was to take a shower... which feels great.

I will post more in the follow days to let you know how things progress. The urologist's office just now called to check on my well being. I have a follow up with the urologist and the radiation oncologist next month on the 21st. I am relieved the procedure is done and now behind me. Both docs felt all went very well. I would answer questions that anyone my have regarding this procedure. I felt like this was the best option for me and glad it is a one time treatment option.We all have our fears and anxieties, but we work through them. Good luck to us all.

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Great post Charles, look forward to your updates.

 

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Hello, it is interesting to read your story and may help people considering brachy. My other half had brachy Jan 2015. Unfortunately suffered bad side effects and still suffers burning on peeing 14 months later. He gets a lot of pain in his prostate too, the pain, like yours started after the biopsy, he was given antibiotics and in total had them on and off all year. GP has now given another lot. The burnng started after the brachy. Seems no one can help. Apperently this is very rare. On the plus side psa is 0.61.

I hope you get on well after your treatment.

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Here I am at day 2 after the Brachytherapy. I slept well. I awoke this morning around 5:00 a.m. needing to pee. It was not an urgent need, but none the less I needed to get up and go. For this first time of the morning, the urine stream was very weak. It took me a longer while to finish. And then I felt like I had not emptied my bladder completely. I stood there for a bit longer and another weak stream finished. I went back to bed and slept for a while longer. I got out of bed around 8 or so. The next visit to the bathroom was better. The stream was not great, but much better than the one at 5 a.m. So now, I got up, had some coffee and read the morning newspaper. Had a small breakfast and took the antibiotic that was prescribed (2 daily for 5 days). I also took the Avodart that was prescribed by my urologist and also more ibuprofin. As far as the very slow urine stream early this morning, what may have contributed to that was the night before, I had eaten some fairly salty popcorn that my friends and neighbors brought over. We get together frequently to have a movie night and they bring popcorn. On my release papers from the hospital, it did mention to try to avoid salt - or only low amounts of salt because it could contribute to swelling. The popcorn was a bit salty too... so I didn't eat lots, but I did eat my share. As the day progresses, my urine stream seems to be okay. I am not having frequent or urgent need to go which is good. I am still very sore in the perenium area, and very purple and bruised there. I still cannot sit straight, but can sit sort of to one side - to sit at the dinning table. It is also uncomfortable to cough or sneeze... Another friend came by and brought lunch for me and my other half today. It is at times like this that make you appreciate the kindness of your friends. Sitting at the dinning table for a while and having lunch was nice. But after a bit, I was really tired and had to excuse myself to lay down. And I understand that I will go through boughts of fatigue for a few weeks to a few months. I think I have a very good urologist who is also an oncologist - and I also have a great radiation oncologist. The two of these doctors work together as a team. My urologist stressed to me that for any treatment that anyone is facing, you need to make sure that your doctors and have performed the procedure many times with great success rates. Both of my doctors have excellent track records. They have performed the Brachytherapy procedure nearly 1500 times over the past several years. So I do believe they have the experience. One of the reasons I was put on the Flomax was as a precaution to help me keep urinating well. I can see that now. Also as a side comment to alfred5 and your other half. I know this must be very frustrating to experience the burning urination. I am so glad that has passed for me. After the procedure, it was very painful to pee for the first several times. Thankfully that has passed. The instruction documents that were given to me upon my release from the hospital on Wednesday mentioned a few things that I should avoid for a while. One being caffein, another being alcohol. So, something to consider with the burning urination would be what you eat and drink that might help. I would think that a good urologist would be able to suggest something for relief whether it be medication or diet. Something should be able to be done. I wish you the best... I will continue post this as the days go on. charles61038

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Hello glad you are doing well yes my other half has been caffeine Free for a year now. Also rarely drinks alcohol as it causes burning. He's also on tamsulosin. All the best.

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You mention going to your GP -  I wonder if a specialist - a urology doctor might offer something to help. I was reading that sometimes the burning could be caused by kidney sand - sort of like very small kidney stones. I had a friend who experienced those. I believe he was given medication to help prevent the sand - which rubs the walls of the uninary tract.  Hoping you find a solution.

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Hello. Yes went to gp recently but he's been back every 3 months to see the consultant that performed the brachy. He's going in 3 weeks again. The consultant just says he was unlucky. I'm going insist something is done this time. He had no problems at all before brachy, he never got up in the night for the toilet had an fairly normal flow. But over a year on he still has poor flow, especially the first one of the day. He always gets up at least once a night. About 2 months after brachy he was getting up every hour. So had a bad year over all. He says he wishes he'd never it done. No going back though. I hope no one else suffers the same. The consultant showed us a chart with how many people had reported side effects, only a low amount and no one reported any after 9 months. We are almost 14 months on and he's still suffering.

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Day 3 and all seems to be going well. I am experiencing a little more frequent need to urinate during the night. I got up twice which is still not bad. No urgency and no burning. It is a little uncomfortable to start, but nothing really to speak of. I also noticed waking up with some aching in my pelvis and legs. Still not bad. Seems like after I get up and walk a bit, the aching is better. After getting out of bed this morning, the aching is gone. The soreness is getting better, although I still cannot sit up straight. The bruising is still very dark purple. I didn't take ibuprofin at bedtime last night because i didn't think I needed it. That may be the reason for the aching pelvis and legs. I took ibuprofin early this morning and will take more at bedtime. My urine stream is not as good as before the seed implants, but still good and not a concern at this time. According to my doctor, I should be back to where I was before seed implants by 8 months. He told me that I would experience some of the side effects slowly up to around 4 months. Then they should start becoming less and less until I am back to where I was before this whole thing started. So for now, no plans to go out and do much activity. I will take it day by day.

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Hello. Yes my other half didn't really get symptoms until 4 weeks after. Though the burning was from day one. He was up every hour at one time. But we have a friend that had brachy a few years ago who had no side effects at all. So it seems to be different for everyone. Like I said burning continuing 14 months on. Not all the time, he gets good days and bad days. He continued working on the farm right through. I think he'd have struggled in a job with no toilet though as he works outside he could go when he wanted which helps. There's no one else about.

I hope continue to do well.

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So good of you to go into such details of your operation. I wished I hadn't read it now to be honest and that it had just been spung on me! But it  has encoiraged me to go for this treatment rather than the removal surgery I had initially thought of having done as soon as I heard that I had PC last week.

Ash 

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Ash, I can tell you lots more about my experience with the Brachytherapy. It has been one year this month and I am doing very well. As I have read other men's experiences with other treatments, I am glad I chose the Brachytherapy. Especially since it is a one time treatment - 45 minutes as an outpatient procedure. The first few months I had some discomfort with inflammation from the radiation, but since it is low dose it is not so bad. Over the counter pain relievers work... ibuprofen, tylenol etc. I was prescribed Tamsulosin (generic Flomax) in the beginning to help with the inflammation. It helps keep the urine flowing. For a short while I had to take two tablets a day due to a weak urine stream. The urethra gets inflammed from the radiation. I would get up at night 2 or 3 times. And sometime feel like I didn't empty my bladder completely. I could walk around the house a little bit, then go back and finish emptying my bladder. Now I don't take any of the medications and all is well. The half life of the low radiation seeds is about 4 months. Things get better quickly from that point. I went for my six month follow up last August. At that time, my PSA was at 0.15 which my urologist said was excellent for that time. Tomorrow I have an appointment with him - for my one year check up. I will let you know how that goes... and I think it will be a good one. At this time, I feel like I did before this whole thing happened. I am back to normal. No incontenence, no erectile disfunction. All is good. I can explain in more detail about any aspect of this journey if you would like. I would be happy to share my experience. As my urologist advised me in the beginning, what ever treatment option you choose, just make sure the doctor has performed that procedure many times successfully. And that is good advice. My best to you.

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Ash, I hope I didn't scare you with this story. I really hope not because I think from what I have read from others, the Brachytherapy is a very good choice of treatment. It is over quickly and the side effects are mild compared to some treatment options. I have a good friend that retired from the Cancer Research Center - she was a radiation specialist. She explained options to me and also the side effects that go with them.  Any radiation has some side effects, but the fact that the Brachtherapy is such a low dose makes the inflammation less. I didn't experience any problem with bladder or colon issues as some have with traditional radiation (and not everyone on traditional radiation does). I just came back from my appointment with the urologist - my one year check up. Great news from him. My PSA is at 0.11 which he said was excellent. I will see him again in6 months - August. And he also said that after that appointment I would probably be seen one a year. If you don't mind, can I ask where you are located? And what your choices are for the Brachytherapy treatment. I live in San Antonio, Texas and I have a really good urologist who is reallly excellent with the Brachytherapy procedure. He has done it hundreds of times with great success. I look forward to hearing from you again. Just remember, this can be cured and your life can go on just as good as alwarys. Good luck to you.

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Thanks for your reply Charles.  I suppose after being so fit and healthy rarely seeing my doctor for anything other than severe flu now and again, the thought of any surgery is daunting.  

I am actually in the UK so will need to find the best man for the job over here whichever course of action I take. I had decided on brachytherapy but tonight reading more on-line literature I am not so sure again. I read that the only sue way to ensue the cance doesn't return in years to come  is to remove the prostate  - which is logical  - but I don't fancy the 3 month recovery period and long term ED attached .....especially as I'm not all that strong in that area at the moment anyway without the blue tablets so I  may be throwing the baby out with the bathwater  going down that route  -  I don 't know.

I really need to speak to one or two consultants  face to face before making the final decsion.  

 

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Ash, you don't say what your PSA or Gleason score is. If you are in the low to intermediate risk group, I wouldn't do the radical prostatecomy. That is major surgery and you can be cured without that. What did you read that made you re-think Brachytherapy? I found a website that I found to be helpful with making a decision. It is called the Prostate Cancer Treatment Reasearch Foundation. (pctrf dot org). In this website, you can choose in what risk category you are, and it helps you see what treatment options are available to you. It also shows the success rates for each over a 15 year period. You can compare the varios treatments on a chart. Surgery has a good success rate, but Brachytherapy does too at a much less invasive treatment. Everyone has to make their own choice with this, so take your time. Hopefully your numbers are low enough that you have time to decide. Oh yes, I had my one year follow up this past Wednesday and all was great. My PSA is now at 0.11. My urolgist said that is excellent for one year. I will see him next in six months - August. He said from what he sees, I will probably see him annually after that. I am luck that I have a very good urologist who has done the Brachytherapy procedure many times and has written about it. His name is Dr. Michael Sarosdy and he has information on the web about Brachytherapy and other treatments. He is with South Texas Urology and Urologic Oncology. I also had an excellent oncologist that worked along side Dr. Sarosdy. Dr. Ardow Ameduri. Both of these doctors helped me along the way with their encouragement. I hope you can find good physicians to help you with the difficult time. Just remember, you can get past this and live your life. No matter what treatment you choose.

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Thanks for your informed advice,

My Glleson score is 3 +4 = 7

PSA 5.52

I amgreatly emcouraged by your message . It was the pctrf web-site which made me re-think my initial thoughts.  I am waiting for a appointment to chat to the consultant and hopefully my decision to go for brachytheapy will be confirmed as being the best option.  I don't fancy the radical surgey if i can avoid it .

Ash

 

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With any treatment there are side effects. I think the Brachytherapy (at least for me) was torerable. There were good days and not so good days. Radiation of any kind causes some inflammation, but ibuprfen helps with that. It also causes some fatigue, but on those days, you just take it easy and rest if and when you can. At least with the Brachytherapy the radiation is a very low dose which makes damage to the surrounding tissues little to none.

I will look forward to hearing how your appointment goes with the consultant. Wishing you the best.

Charles

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Thanks Charles     -  Let you know what ensues. Appointment is in a couple of weeks they say.

Ash

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I just ran across our discussion here. And I was wondering how you are doing. Did you make any decision of treatment? I am still doing well after the Brachytherapy. I have my annual physical at the end of this month, and my primary care physicion will most likely do a DRE which is okay with me just to make sure all seems good. Then, next month I will have my 1 year and 6 month follow up with the urologist. I am hoping that he will tell me that I can now see him only annually from then on. I hope all is well and good with you. - Charles

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Hi Charles,  Thanks for getting in touch. Well,  things have moved on in some ways     unexpectedly.  Because my flow rate wasn't strong enough on the day of taking the measurement (tablets helped this - except on the test day at hospital ...nothing!!!) So on that basis, I was  told that removal of the prostate was th only option - brachiatherapy  could make the flow rate even worse which would be problematical.

Anyway, I had  come across a therapy involving high intensity focused ultrasound (HIFU). There;s only one place here in the UK doing it  - in London. Apparently it was in a trial stage . Anyway I went down to chat to the consultant who advised me I seemed a good canditate on the face of it  - the other hospital having failed to send all my notes across. He called me i for a fresh MRI scan and having had that done  - I am popping down  mid July to talk to the consultant again to see if I am a candidate on the basis of the new results. I really hope so as this threatment is the least invasive  - minimal side effects, and in and out the same day.  The success rate is around 85%  ...as for it being a ''trial''  - the consultant assured me that though technically it was still classified as a trial  - he had been carrying out the procedure for the last 10 years.  I'll let you know what happens.

Ash

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Ash, so good to hear from you. I've heard great things about the HIFU treatment. And it's great that it is not an invasive procedure. From what I've read about it, side effects are few and risk is low. I just think if you can avoid major surgery it is a good thing. And you say that your consultant has done the procedure for 10 years speaks well for him. I wish you the very best. And I look forward to a good report from you. Charles