Monday, December 4, 2017

Questions to ask a high dose rate (temporary implant) brachytherapist

HDR Brachy monotherapies doctor questions
1.        I assume we are talking about monotherapy only, without external beam radiation or hormone therapy – is that correct for my case?
2.       How many monotherapies have you performed? How many combined with external beam?
3.       How has your practice of HDR brachy changed over the years?
4.       What is your 5-yr freedom from recurrence rate for patients at my risk level? What proportion of your recurrences were local?
5.       What kind of urinary and rectal reactions can I expect? How long can I expect them to last? What medications or interventions do you typically give for that? Should I expect those symptoms to recur later?
6.       What is your rate of serious (Grade 3) adverse events? Do you see urinary strictures? Urinary retention requiring catheterization? Fistulas? Rectal bleeding requiring argon plasma or other interventions?
7.       What is the margin you will treat around the prostate? Is it less on the rectal side?
8.       What is the prescribed dose to the planned target volume?
9.       What is your treatment protocol? Number of insertions? Number of fractions? Dose per fraction? Can we vary those for convenience?
10.    What kind of imaging do you use for planning? MRI? CT? US?
11.      Do you increase dwell times in areas of known cancer?
12.    Do you use fiducials or Calypso transponders?
13.    In my treatment plan, what do you identify as “organs at risk” and what dose constraints do you put on them?
o    What dose will my penile bulb receive?
o    How do you limit urethral dose? (e.g., catheter)
14.    How long does each treatment take?
15.     How will I be immobilized/anesthetized during each treatment? What kind of analgesia is used?
16.    Are there any bowel prep or dietary requirements?
17.     Should I avoid taking antioxidant supplements?
18.    In your practice, among men who were fully potent, what percent remained fully potent 3-5 years later?
o    Have any men retained some ability to produce semen?
o    What is your opinion of taking Viagra preventatively?
19.    Do you monitor side effects with the EPIC questionnaire?
o    In your practice, what percent of men experience acute urinary side effects?
o    In your practice, what percent of men experience acute rectal side effects?
o    In your practice, what percent of men experience late term urinary side effects?
o    In your practice, what percent of men experience late term rectal side effects?
20.   What kind of PSA pattern should I expect following treatment?
21.    What is the median PSA nadir you are seeing in your practice, and how long does it take to reach that, on the average?
22.   In your practice, what percent of men experience biochemical recurrence?
o    What % of those have been local?
o    If there should be a biochemical (PSA) recurrence, what would the next steps be?
o    Have you ever used SBRT, brachy, or cryo for salvage after a local HDR brachy failure, and was that focal or whole gland?
23.   Are you open to email communications between us?

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