Dear vaac-ga;
Thank you for allowing me an opportunity to help you with another question.
?I do not understand this. If the cancer, including those portions of
it which do not respond to hormonal treatment, will be killed by the
brachytherapy - why follow after April with external radiation??
It?s actually difficult to say without knowing quite a bit more about
your specific situation. The truth is not everyone who has
brachytherapy actually needs follow up radiation treatments in all
cases. It may be that you physician feels the brachytherapy basically
?did the trick? and just wants to be safe by following the treatment
up with radiation, but does not see radiation as a dire necessity (but
only he could answer this for certain, of course).
In addition, the proximity of time with which your brachytherapy is
followed up with radiation may be directly related to the type of
isotopes used in the brachytherapy itself. The theory is that stronger
isotopes such as palladium-103 (usually given to those higher on the
Gleason scale) may be more effective that those who receive iodine-125
(usually given to those with lower Gleason ratings). So if you
received a stronger isotope it may be that your situation does not
warrant immediate radiation follow up ? at least perhaps not in the
urgent sense.
?If not - would it not be more efficient to do the external radiation
as soon as possible after brachytheraphy before the cancer has had a
chance to recover and "repopulate?"
A couple of things are important to note with regard to the biology of
both the prostate and most cancers involving the organ:
First, cancer grows ? or seems to. In reality, cancer does two things:
it ?spreads?, and ?recurs?. Cancer is not like an virus or a bacteria,
per se, inasmuch as it ?repopulates?, as you called it if left alone
to multiply like this infections typically do. Rather than ?re-group?
or ?recover?, it simply returns if the conditions are right and
continues a relatively predictable growth pattern or in some cases
comes back and metasticizes to other places. In effect, cancer is
cancer until it is all gone; in other words, as long as the cancer is
present it is still a cancer even if it is in remission. What the
external radiation does is basically clean up, if I can use a layman?s
term here, to HELP INSURE that traces of the disease are also ?killed?
in the hopes that the every presence of the disease is destroyed. An
analogy might be comparing brachytherapy to a rifle bullet, targeting
a specific point, while the follow up radiation is more like a
shotgun, targeting a general area. The urgency of this clean up
therapy depends on many things, not the least of which is the success
of your brachytheraphy, the type of cancer you have, the overall
health of your prostate and body and the types of isotopes used in the
seeding.
Secondly, almost all patients have some inflammation of the prostate
(prostatitis) after seeding which typically resolves as the seeds lose
their energy. You mentioned the likelihood of the cancer ?recovering?
but just as importantly are the health of the prostate and indeed the
entire body. As with any invasive procedure, a healing time is in
order (whoever long or brief). It may be that your physician has
weighed the risks against the possibility and probability that your
cancer might recur TO SOME DEGREE against the overall health of your
prostate and has determined that it would be more (or just as) prudent
to wait a short time to do the radiation for the sake of the
prostate?s health.
Finally, if your prostate cancer is so voracious that radiation
treatment is absolutely necessary immediately following
brachytheraphy, you would probably have had many discussions with your
physician, and he with you, about seriously considering options to
remove the cancer surgically rather than with radiation treatment.
Suffice to say that unless your cancer is terminal and follow up
radiation treatments are merely a last ditch attempt to help combat
the disease (which obviously does not seem to be the case here or you
would probably have had a prostatectomy by now to remove the entire
organ and surrounding tissues in spite of your heart condition and
your age), it is very unlikely that you physician would even consider
agreeing to your travel plans and postponement of your trip abroad.
It seems that the majority of patients undergo external irradiation
2-3 weeks following brachytheraphy but the urgency undoubtedly hinges
on the patient, the type and stage of the disease, and the
recommendation of the attending physician. I have seen where some
therapies were put off for ?watchful waiting? for 5-6 weeks and in
other cases where external irradiation was applied in advance of
brachytheraphy. I would highly recommend you meet with your physician
to discuss your concerns and lay it all out on the table with him/her
just as candidly as you have with me. The bottom line may very well be
that the period between your brachytheraphy and external irradiation
is directly related to how well you responsed to the brachytheraphy
seeding - which by all accounts would be considered good news in
itself, and you can carry on with your travel plans. On the other
hand, you could insist that the treatment be done immediatley just to
be cautious and you'll either get an explanation as to why you must
wait, or you may have to postpose your trip in order to complete the
five week treatment. In the end, what you learn from this experience
will be commensurate with how well, how intelligently and how
effectively you take charge of both your own treatment and ultimatley
your fate.
I hope you find that my research exceeds your expectations. If you
have any questions about my research please post a clarification
request prior to rating the answer. Otherwise I welcome your rating
and your final comments and I look forward to working with you again
in the near future. Thank you for bringing your question to us.
Best regards;
Tutuzdad-ga ? Google Answers Researcher
INFORMATION SOURCES
UROLOGY TIMES
http://www.urologytimes.com/urologytimes/article/articleDetail.jsp?id=81734
HIGH DOSE RATE BRACHYTHERAPHY
://www.google.com/search?q=cache:Gv79JAF3tugJ:www.medscape.com/viewarticle/423510_2+%22weeks+following+brachytherapy%22+ebrt&hl=en&ie=UTF-8
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brachytheraphy, ebrt, external irradiation, external radiation,
prostate, urgency, time between, followed by, treatment period,
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