Possible complications of HDR « Prostate Cancer News

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http://prostatecancernews.wordpress.com/2008/04/01/possible-complications-of-hdr/

I have

prostate cancer (psa was 14 - 7 4+3) My Urologist did a biopsy (30 samples were

taken, only one came back showing cancer). I chose extermal + hdr radiation,

after the marker seeds were inserted I came down with a very bad infection

(klepsielia) was in the hospital 5 days and antibiotics thru a PICC for another

5 days. I started external radiation a week ago, my 2 doctors are hesitant

about doing HDR because of my high risk of getting infections. I am also taking

hormone shots. My question is would the extermal + hormones be sufficient

enough treatment and is there a percentage figure floating around from studies

on the cure rate?? I read a form they want me to sign and it indicates many

possibilities of complications from hdr. I am asking because my oncologist is

away until tomorrow and I an sceduled for an ultrasound.

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I am

assuming that the 7 4+3 was your Gleason grade. You made no mention of the

actual extent of the prostate involved (this is called the T stage, usually

described as to whether 1 or both lobes of the prostate are involved). You also

made no mention of your age, I am assuming that you are expecting at least

another 10 years.

The

available information makes you intermediate risk for recurrence. For patients

like you, external beam is a valid option with or without the brachytherapy

(HDR). Hormones are controversial for intermediate risk disease (but not for

high-risk disease, if your T stage is 3a, you would be high not intermediate

risk). I’m thinking you are more likely intermediate risk, as

brachytherapy is not commonly used for high-risk.

Looking

at studies concerned largely with intermediate risk disease, the use of

external beam radiotherapy with hormones shows improvement in survival at 5

years (88% vs 78%) compared with radiation alone. Two other studies

showed improvements in terms of PSA remaining low usually called freedom from

progression. The approach remains controversial as the best experience with

hormones involves larger studies in high risk patients.

Using a

statistical model (nomogram) with your data , your freedom from

progression would be in the order of 60-70%. While this seems modest,

bear in mind that a rising PSA does not always translate into reductions in

survival. At 5 years, the chances of having a metastasis would be around 10%

only.

You may

wish to discuss the estimates with your doctors – as the radiation dose

would also play into the estimates.

The

decision to continue the HDR is hard to recommend if you’ve had some

complications already and it is afterall optional (since you still have

external beam). Of course, the particular complication which was infection is

avoidable, so there is no compelling reason not to go through with it either.