I was diagnosed with early stage disease in July of 2008 with 5 positive cores - one on the right with 5%, 4 on the left: 2 at 5%, one at 50% and one at 60%. I did EXTENSIVE research and consulted with a robotic surgeon, several radiologists (photon and proton) and several "seed" doctors. I considered, very seriously, not treating or delaying for a future date when the condition advanced but nearly everyone advised that I was too young for such a strategy. I learned that any of the major treatments would almost certainly cure me, so I looked for the least side effects and settled on High Dose Rate (HDR) Brachytherapy which was done in December of 2008 at William Beaumont Hospital in Royal Oak, Michigan. Here is how it went.
I had to travel for the treatment so I set it up beforehand. I saw the doctor for a consultation on a Monday and then had an Ultrasound Volume Study. The study requires an enema the evening before and another that morning. You are placed in the position you will be in for the implant - on your back with your legs in stirrups spread wide and well back. A catheter is inserted into the bladder and some contrast material inserted to define the bladder. The ultrasound probe is placed in the rectum and the images captured on the computer. There was no real pain or discomfort. The doctor found that my prostate volume was more that we had thought (47cc) but was still within acceptable limits.
I had a few days off during which the doctors and technicians worked out a plan. The implant was on Wednesday morning. I had to go through bowel prep on Tuesday and I was given 2 more enemas upon arrival at the radiation lab. I was given a spinal and an epidural was placed in my back, followed by sedation - I do not remember anything further, but can report that I was put back into position and 17 small catheters were inserted into my prostate through the perineum. A urologist inserted a scope into the bladder to verify the placement of the catheters and my first radiation treatment was done. I awoke on my way to my hospital room - elapsed time about 4 hours - with a Foley catheter in place. I remained on my back in my room (you can not sit up because the catheters remain in place) for about 5 hours when I was transported back to the radiation lab for treatment #2.
This time I was awake. I was again placed in position and the position of the catheters was carefully checked and adjusted. The catheters were hooked up to the afterloader and I received my second treatment. Then the catheters were removed and I returned to my room where they took out the epidural. Note: Beaumont normally does 1 implant with 4 treatments, but are now employing 2 treatments in favorable cases such as mine.
I was soon eating and walking the halls, but I found that I could not urinate after they removed the catheter. This required that I spend the night in the hospital. I had to have a temporary catheter inserted twice to drain urine but eventually the drugs worked to reduce the swelling in the prostate and I was able to regain acceptable function. I was discharged at about 3:00 pm on Thursday.
Outside of minor urinary annoyance with frequency and urgency, I have had no problems. There was no bruising or pain at the implant site. I remain able to have erections and intercourse is as it was prior to the procedure. The entire thing was easy and without any complications or difficulty except for the time it took to regain urinary function. If you are a candidate for this treatment, I recommend it highly.
I will be posting updates on my PSA going forward.
At first followup, my PSA is down from 5.8 at diagnosis to 1.2 and my urologist reports that he can barely feel it on DRE - all at only 3 months.
However, the ejaculate is still bloody and I have some erectile difficulty about 75% of the time. I am told that these problems will likely resolve in time. CIALIS works great so I really have no problems!
The second followup to treatment was on 16 July 2009 - about 7 months since treatment.
My prostate remains small and without any hard spots. PSA is now 1.1, slightly below the last test. I have no urinary problems at all. I am using Cialis (which is very effective) but I find that I do not always need it to achieve a good erection.
I have had blood in the ejaculate since the treatment but this has been improving and is almost clear. I feel great.
Latest update on treatment (November 2009) at 11 months shows continued drop in PSA, now 0.9.
Minor ED is very easily treated with Cialis taken daily (5mg) - which I have to say has turned back the clock and made me feel like a much younger man. Doing great.
Fourth followup after treatment (15 months) results: PSA = 0.9 - steady, no "bounce" DRE = "Flat", nothing felt Overall, I feel great and have no side effects that are not readily treated with common drugs.
Good news! Latest followup (21 months) shows continued drop in PSA. I am now at 0.5, steadily declining ever since treatment.
Feeling great, no side effects beyond mild ED which is easily treated with low dose Cialis daily.
Latest followup at 26 months post treatment shows that the decline in PSA continues - now at 0.40. My Urologist continues to marvel at the great job they did in Michigan!
No problems at all. It may be time to think that we have a "cure".
Continuing monitoring shows excellent results. Latest followup on 24 August 2011 shows that PSA is down to 0.2 and the doctor who performed the procedure reports that his patients who reach 0.4 or less have a 94% cure rate.
Also, I no longer need Cialis as my ED has completely disappeared. Either the condition was related to the procedure and I have fully recovered and/or the daily Cialis was therapeutic. I now feel fully normal!
Latest followup on 22 February 2012, 39 months after treatment shows a PSA of less than 0.1!
Update of 22 August 2012: Prostate "flat" by DRE, PSA=0.1, no side effects nearly 4 years after treatment.
Latest checkup - PSA is <0.1 on 20 February 2013 (50 months after treatment). My PSA is nearly undetectable for the last year.
Latest followup (now 56 months post treatment) shows PSA of less than 0.1. PSA has been at 0.1 or less for 18 months (4 tests). No problems at all. If this is not a "cure" at least I can see it from here. Note: Doctor says that the proper term is NAD - no apparent disease. Informally, the Doctor tells me that I will not die from this disease no matter how long I live!
I believe that the choice of HDR Brachytherapy was, for me, absolutely the best and the success I have been blessed to receive is OUTSTANDING.
Another update: 20 August 2014, PSA=0.1 (nearly 6 years post treatment). I have been at 0.1 or less for 2.5 years! I have been assured that I will never die from this disease. Feeling fine. Although I do not always need Cialis I find that 5mg when desired is helpful. I do note that I have lost volume in ejaculate either because of the treatment or because I have reached 7 decades in age. Feeling is the same so no matter.
Latest update on 5 August 2015: PSA = 0.10, Prostate "flat", no problems at all. Basically, cured.
This update is merely to inform that I am "cured" - although the doctors never use this term - and have ceased even to monitor the situation. I truly wish that everyone achieves this outcome.
Latest PSA (12/14/2016) remains <0.1.
James's e-mail address is: jweidener AT weidener.com (replace "AT" with "@")