Re: Brachytherapy and salvage

[Guest guest]

LYNN wrote:

> Since my husband can't be treated until August when his

> Medicare kicks in, I am left to my own devices and research.

> Which translates to my mind coming up with odd questions!

>

> My question is, if brachytherapy (LDR) permanent seeds, fails,

> do they do salvage radiation? If yes, do the seeds cause any

> problems with the radiation? The reason I ask is that one seed

> doctor we spoke with said that radiation bounces of the seeds

> and does funny things. Now, this very easily could be that he

> said this because he does IMRT then seeds. So, he may have had

> a vested interest in saying that radiation can do funny things

> on seeds.

>

> So, does anyone know if you can do radiation as a salvage

> treatment to brachytherapy if it fails?

Hello Lynn,

I'm not a doctor but it is my understanding that radiation cannot

be repeated after a failure. I don't know the exact reason why,

but I suspect that the success rate is very low and the side

effect profile is very high. It may be that if radiation didn't

work the first time it is unlikely to work a second time, but the

side effects will be much worse. In other words, I suspect that

a patient is more likely to be harmed than helped by salvage

radiation after previous radiation.

So I'm guessing that the radiation oncologist that you spoke to

meant what you thought he meant - that the IMRT should be done

before the seeds are implanted.

Some radiation oncologists will take an x-ray photo of the seeds

some time after they have been implanted. If it appears that

some area of the prostate that they meant to seed does not have

a seed in it (for example because the seed they places has moved

- it can happen), they will place another seed or a few more

seeds in the prostate. You can ask the oncologist if he does

this and maybe he can say why he does or does not (if he tells

you, please let us know.)

If radiation fails, the most common step after that is to use

androgen deprivation therapy ( " ADT " ). That does not cure the

cancer but can slow its development, sometimes by a great deal.

There are some experimental therapies that have been tried after

radiation that do attempt to cure the cancer. The ones I've

heard about are HIFU (HIgh Frequency Ultrasound) and cryotherapy.

I don't know how successful they are or what additional side

effects they impose. However if the radiation does not work it

may be that the cancer had already escaped the prostate before

radiation. In that case no " local " therapy will cure the patient

and ADT is most likely to be prescribed.

Incidentally, the delay of treatment until August will probably

not be a problem. Prostate cancer is usually very slow growing

and studies have shown that delaying treatment by a few months

usually has no impact on outcomes.

I'd like to suggest that your husband use the time to get himself

in good physical shape before the treatment, if he isn't already

in shape. The radiation seems to cause people to tire out quite

a bit during the treatment and for a while afterwards. Being in

good shape can help.

Best of luck to both of you.

Alan

[Guest guest]

Chuck Maack wrote:

> Yes, external beam radiation can be administered either as

> adjunctive therapy along with seed implants, or later as

> salvage therapy should the seed implants appear to have failed.

....

I had been under the impression that radiation was never used as

a salvage therapy after prior radiation. My own radiation

oncologist told me when I asked him about it that, if I ever had

a recurrence, further radiation was out of the question.

So, surprised by Chuck's statement, I did some research and found

that it is indeed sometimes used.

Here is one article discussing salvage brachytherapy performed on

37 men, 32 of whom had had external beam radiation and 5 of whom

had brachytherapy. It doesn't say if any of them had both.

http://www.ncbi.nlm.nih.gov/pubmed/20138442

and another study of salvage brachytherapy on 22 patients:

http://www.ncbi.nlm.nih.gov/pubmed/18201939

I'm surprised that I've never come across this before. But I now

stand corrected.

I apologize for my previous incorrect statement.

Alan