Radiation treatments: Why choose external beam over brachytherapy?

Is you your medical team suggesting only radiation?

Do you have a medical team, urologist, oncologist and radiologist?

Have you discussed doublet or triplet therapy with your medical team - https://pubmed.ncbi.nlm.nih.gov/37055323/?

Have you discussed having a PSMA PET CT.

Consider starting with the NCCN guidelines (https://www.nccn.org/patientresources/patient-resources/guidelines-for-patients). The NCCN Guidelines for Prostate Cancer provide a framework on which to base decisions regarding the workup of patients with prostate cancer, risk stratification and management of localized disease, post-treatment monitoring, and treatment of recurrence and advanced disease.

Kevin

Thanks 4 the response,I’m 68 yes 1st time ,had both MRI and PET SCAN Gleason score 4+4 Last PSA 11 and a fraction.

Yes i have Med. Team,I’ve chosen radiation over surgery.

If you've read robertmizek's post, radiation as a mono therapy for GS9 and GG 5 may not be the best decision.

Just because imaging doesn't show spread to lymph nodes, bones or organs doesn't mean there isn't micro metastatic prostate cancer there.

Radiation is useful for spot treatments when imaging shows PCa, otherwise it's like using dumb munitions and "hoping."

I'm in the camp that says hope is not a method...

The clinical data you provide says high risk cancer. That requires a more aggressive approach in treatment.

Your call but I would read up on the NCCN guidelines, the Prostate Cancer Foundation has very good patient guides also.

Kevin

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.

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.