Has anyone had HDR Brachytherapy for locally advanced Prostate cancer

I was also thinking about HDR Brachytherapy with Dr. Chang at UCLA, he has done over 1500 procedures and was recommended by the Prostate Cancer Research Institute when I reached out to them. I also have localized PCa as per my PSMA PET scan, only 2% of my 50.4CC prostate, I have Gleason 4+3=7 and I'm 70 years old. There just does not seem to be very many radiation oncologists that mention or recommend Brachytherapy and Mayo Phoenix does not do the procedure once they got their Proton machine. I have been researching BT and there are also side effects just like regular radiation, but I would think they are less as it's more targeted. The procedure des not reimburse as well as other RT procedures. I am just disappointed that in the year 2024 there is not a procedure for localized small volume PCa with little to no side effects. I may just do Active Surveillance for a few years and enjoy my early 70's as much as possible. My Decipher score was only 0.38 so low risk of metastasis 3.4% 10 years and 3.4% of risk of death in 15 years from PCa ( with standard of care treatment) but even with no treatment even if it doubles, that's still only 6.8%

I'm 71, Gleason 9, Stage 2; PSMA PET Scan shows no metastasis and no spread, just one big tumor (~1.5cm) in the right side of my enlarged prostate (~65cc). I'm reasonably fit & healthy.

After much research and several consultations, I decided on HDR Brachytherapy with Dr. Chang at UCLA, followed by 5 treatments of SBRT.

Because my PC is high-risk, I'm glad Dr. Chang treated my whole prostate plus local lymph nodes.

I finished these radiation treatments just recently (end of March 2024).

Side effects so far?
1. I started Flomax (Tamsulosin) just prior to treatment... no issue with urine flow, but there is increased frequency & urgency. And I needn't have worried about the urethral catheter: It was inserted while under anesthesia, and easily removed a few hours later before I was discharged.
2. For me, bowel movements are also more frequent & urgent, which I believe is a result of the rectal spacer (SpaceOar), which apparently causes smaller-diameter lower-volume poop. At my 1-week follow-up, Dr. Chang said pooping should improve as SpaceOar slowly dissolves over the coming months. I regularly use a stool softener anyway, so I increased my dose to prevent any hard poop & constipation. And I follow a high-fiber diet with lots of leafy greens. But strangely, after HDR Brachytherapy, only a bland low-fiber diet is recommended, soon progressing to your regular diet as tolerated.
3. I wake at least 3-4 times a night to pee or poop -- only somewhat worse than my pre-treatment routine.
4. Flomax lowers my blood pressure... light-headedness, especially if I stand up too quickly.

Of course, my treatment plan includes ADT; I started Orgovyx 6 weeks before HDR Brachytherapy, with typical side effects (hot flashes, fatigue, loss of libido). And the resulting low testosterone can cause a loss of muscle mass. So I continue my regular brisk walking daily (2-3 miles) and workout with free weights. Some days, initial fatigue makes it difficult to start, but once I get going my exercise habits kick in. (OCD can be a good thing.)

That's about it for now. Of course it's stressful -- and sometimes very unpleasant -- but it's all been tolerable.

Best wishes.

"There just does not seem to be very many radiation oncologists that mention or recommend Brachytherapy..."

I had HDR Brachytherapy as a mono therapy last June at Mayo/Rochester. Depending on which classification you choose I had a low/moderate risk cancer which was contained to the prostate. I was told they can target lymph nodes; this is a question that you should ask your radiation team. My treatment consisted of two procedures two weeks apart. Each session I had anesthesia, the wires were placed and left in for 10-12 minutes (depending on the dose needed) and I went home that day. Side effects were minimal, I was placed on Flomax for 30 days which was helpful, but I felt I could have got by without it (others describe more difficulty than what I had). I did experience fatigue 2 days after the treatment but was able to get back to my exercise routine by the end of the week. ED with all forms of radiation is a possibility. I am 10 months from my treatment and doing well with the PSA moving in the right direction.
I chose HDR since it was only two treatment procedures, the research shows it has one of the lowest recurrence rates, fewer side effects and quick recovery compared to surgery, and a well trained and experienced RO can place the dose exactly where it is needed.
There are some very good videos regarding HDR at PCRI.org that you may want to look at. It also never hurts to get a 2nd or 3rd opinion.

Has anyone had Focal Therapy for Prostrate Cancer?

Thanks for the information and it sounds like you are doing well. I’m also going to be contacting Mayo Clinic about Brachytherapy. May I ask what Radiation Oncologist you used. Thanks.

Dr Jessica Wilson

Thanks so much for all of the information. I’ve had a consultation with Dr. Chang and I’m leaning in the direction of Brachytherapy + SBRT. I too am also on hormone treatment but will have to be on it for two years because of my lymph node involvement. Best wishes to you and stay strong.

Thanks so much.