Respectfully, you seem to have a bias against RP with a bias towards RT based on non-peer reviewed published data. I used to have the same bias. I read the same papers, visited the same website, and reviewed the same charts. I also watch countless videos from Dr. Mark Sholz who is a highly regarded Radiation Oncologist. I also called the PCRI hotline for information before I selected radiation (brachytherapy) as my primary therapy in 2020. I was assured that I’d never have to worry about PCa again and that if it reoccurred I’d just receive more brachytherapy seeds and it would never be life threatening. And guess what? It failed. Miserably. I was diagnosed with aggressive Stage 3a N1 PCa with a Gleason score of 9 and a 50% chance of surviving 5 years. More seeds weren’t an option. IMRT was nearly guaranteed to create a stricture and the need for a urinary diversion for the rest of my shortened life. Luckily, I found a surgeon skilled in salvage RP after brachytherapy who removed the prostate and every lymph node that he could safely reach. I’ve now also received 31 sessions of salvage radiation to the pelvic lymph node basin and am on first and second generation ADT for 24 months. They given me hope of a cure and a life expectancy over 5 years.

5 different doctors including 3 radiologist-oncologists reviwed my case and commented that brachytherapy alone was inadequate primary treatment. I should have received a combination of brachytherapy with EBRT and 6 mos of ADT OR surgery with the possible addition of RT to the prostate bed and 6 mos of ADT.

What’s my point? I no longer project a bias toward any particular treatment as every case may have nuances that don’t fit my bias. Prostate cancer is a complicated disease and while you and I might be brilliant in non-medical pursuits we don’t have the knowledge or education to be recommending treatment to other men. We can share our experiences with PCa and the treatment we received but shouldn’t project our bias’ to other forum members. I used to speak publicly at the local prostate cancer foundation about the curative benefits of brachytherapy for low and intermediate risk PCa. I was the local “poster boy” for positive outcomes for almost 3 years. The local doctor who practiced brachytherapy benefited from new patients that sought care with him after they heard his pitch and my testimony at the meetings. My heart was in the right place but I hope none of them had the same poor results I had.

Good luck on your journey and wish me good luck on mine.