Monday, December 4, 2017

Questions to ask a low dose rate (seeds) brachytherapist

Questions for LDR brachytherapists

1.     How many have you performed?

2.     How has your practice of brachytherapy changed over the years?

3.     What is your 5-yr freedom from recurrence rate for patients at my risk level? What proportion of your recurrences were local?

4.     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?

5.     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?

6.     For how long should I refrain from sex with a partner?

7.     For how long should I refrain from close contact with people and pets?

8.     Among men who are previously potent, what percent of your patients return to baseline?

9.     Do you recommend ED meds as protective?

10. What kind of dose with which isotope do you use? Would adjuvant IMRT be given with that? Would hormone therapy be given with that?

11. How do you prevent seed migration?

12. Do you use “intra-operative planning” or some other technique to guide placement and assure adequate seed distribution? Do you use a template with ultrasound guidance, cone-beam CT or some other method?

13. What do you set as dose limits for organs at risk? How do you assure that urinary sphincters, the urethra, and the rectum are spared?

14. Do you do a follow-up CT or MRI after a month?  How often do you find you have to go in again to treat cold spots?

15. How will we monitor PSA? What kind of PSA pattern can I expect?

16.  What kind of aftercare (including sexual rehab) will you provide, and how will we monitor side effects, and for how long? Will you regularly monitor my urinary and erectile recovery progress with validated questionnaires like EPIC and IPSS?

17.  In your practice, what percent of men experience biochemical recurrence?
    • What % of those have been local?
    • If there should be a biochemical (PSA) recurrence, what would the next steps be?
    • Have you ever used SBRT, brachy, or cryo for salvage after a local LDR brachy failure, and was that focal or whole gland?

18.  Are you open to email communications between us?

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