I’m 68 too. I thought our 60’s were supposed to be the new 50’s. Who knew!

I am familiar with brachytherapy and consider myself a “fan” of the procedure. I had focal brachytherapy in 2020 for low risk Gleason 6 PCa. Treatment failed in 2023 and I’m now dealing with Gleason 8 & 9 Stage 3 locally metastatic PCa so while I’m still a fan of brachytherapy my enthusiasm for it has been tempered.

I’m guessing that your RO is of the belief that brachytherapy
Is inadequate as a solo treatment and as a layman I’d agree.
For 3 years I was an active member in the Chicago Prostate Cancer Foundation. It was founded by an RO that specialized in brachytherapy and performed thousands of successful treatments. I recall him saying that brachy as a solo treatment was typically a good choice for low grade and intermediate favorable (G3+4) only. Once the patient had intermediate unfavorable grade (G 4 +3) and higher he would add EBRT to make certain that the whole prostate received enough radiation. I recall that he added ADT for those patients with high grade Gleason 8 and higher.

Gleason 8 is typically considered high risk PCa so whatever treatment you choose, choose wisely. I suggest that you consider and investigate other treatment options before making a final decision. Be your own advocate. If I had a do-over I would’ve had a prostatectomy instead of brachytherapy in 2020. I chose brachy to preserve my sex life at age 65. I regret that decision now but life goes on.

Good luck on your journey with PCa.