Brachytherapy? Anyone have thoughts?

Hi Steve. Welcome to the forum and the club no one wants to join. I’m a two-time prostate cancer patient who had Brachytherapy in 2020. My comments are not medical advice, just my personal opinion based on my experience.

The fact that you have “favorable” Gleason 7 PCa is good news because you have a myriad of viable options. I hope you explore them. Brachytherapy has a good track record for treating prostate cancer while avoiding problems with incontinence and erectile dysfunction. I’ll attest to that. i had zero problems with urinary urgency and no issues with ED. The problem in my case was that I was under-diagnosed and my cancer was more aggressive than appropriate for brachytherapy alone. Prostate cancer returned with a vengeance in 2023. It returned as Gleason 9 Stage 3 with local lymph node involvement. I’ve had to undergo Salvage Robotic Prostatectomy, 31 sessions of radiation, and have to be on First and Second Generation Androgen Deprivation Therapy for 2 years. It’s been a rough 8 months all because brachytherapy was the wrong choice for me.

I used to be an advocate for brachytherapy and used to speak publicly singing its praises at the local Prostate Cancer Support Group. I believe that I influenced other men with Prostate cancer to choose brachytherapy. I hope things worked out OK for them.

If I had favorable intermediate risk PCa today I would investigate whether or not I was a good candidate for cryotherapy, a treatment where the cancer is frozen within the prostate. If that failed it would’ve been easier to determine that it failed earlier and I believe that I could’ve been treated with surgery or radiation while it was easier to treat and cure.

Good luck to you on your journey. Please keep us posted. We’re here for you.

Dr Morton at Sunnybrook Hospital in Toronto, Canada . ( A Center of Excellance for Cancer Treatment ) is one of the worlds foremost experts on HDR & LDR Bracytherapy . I personally would consider Monotherapy HDR Brachytherapy . 2 doses - 2 weeks apart . Minimal to Zero side effects .
Discuss this with your Radiation Oncologist AFTER viewing Dr. Mortons video and other background at :
Google : Dr. Morton Brachytherrapy Video .
Good luck .

Here is a good website to compare odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see the odds of 10-20 yr survival, etc. based on the treatment you pick.
https://www.prostatecancerfree.org/compare-prostate-cancer-treatments/
It is best viewed on computer or just print it on paper. Not so viewable on phone.

To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.

Also be aware the the graphs don’t show any salvage radiation benefit. This would boost the surgery odds up a bit.

And, this is a very dysfunctional industry from my view. Loads of bad info mixed in with the good info. Same with the docs. Many of them are more dangerous than the cancer.

@robertmizek gives a good anecdote about how our own experience is at a point in time for a single case, so I won't try to inform your journey with my own anecdote. The treatment practice guidelines are the consensus opinion and they are updated over time. I don't have the link to the charts handy, but I found them a very helpful read when I was [reevaluating the decision I had already made!]
What I did hear about brachytherapy when I asked about it in the decisionmaking process was in line with Mizek's anecdote. Basically, 5 year and 10 year results for people with 3+3 or 3+4 staging is not very illuminating.
For context, brachytherapy (placing of radioactive "seeds" targeting nodules of concern) is in the broader category of selective ablation strategies--killing the known cancer in situ while avoiding damage on a larger scale. I think it was an earlier one, which has now been supplemented by laser, cryo (freezing), HIFU (high intensity focused ultrasound), some radiation therapies, and is still an area of investigation, indicating that no one approach has been so entirely successful that alternatives are no longer being pursued.
To make comparisons harder, generally these strategies require specialized training and equipment, so they have specialized practitioners who are obviously comfortable with their approach, but aren't offering every possible approach and select among them. Centers of Excellence may seek to address this by having a variety of options in house and having committees evaluate each case.

Great comment! I hope your journey is going well.

After 12 years of dealing with cancer doctors, I have found very few that I trust and most of them are definitely in it for the money. And very few have high-level of concern for your health. Not being cynical, but I’ve been this course. And the reason my PSA is at 70 is because, one of my doctors drop the ball. It’s very frustrating.

At my age 57; I’m 70 now,. I was diagnosed with a Gleeson score off the charts, everything was 10 through 16, and yes I know they stopped at 10 but my Gleason’s were horrible. My PSA was 4.87. I had pain and trouble urinating, which is what made me seek doctors. Because of the low PSA I was not diagnosed for almost 2 1/2 years. When diagnosed I immediately started on Lupron and am still on Lupron today. After researching, I decided to go with HDR Breaky therapy at Ronald Reagan Medical Center in Los Angeles. It wasn’t smooth and I had a nine month long recovery. One of the worst in their history. I lost ED function and immediately went on Flomax. I don’t know why I had as much trouble as I did from something that should not have happened. Since then, I have been on several different injections and several different pills like anbuteriane and Erleada. Never once was I cancer free nor without symptoms. Now for my 70th birthday, my PSA is 74 and they are looking to do nuclear medicine on me. Mine has always been stage four from diagnosis and radiation had helped control some of the spread but now it is fully involved in the spine and, becoming painful.
So my thoughts on HDR Breaky therapy was that it was one step of a multi step treatment program. I think more radiation or perhaps a different onset of chemotherapy may have been more effective. But we all have those doubts. I do know Erleada did not work and it was hard to get my doctor to recognize that, I don’t think there’s any treatment that gets rid of all the cancer cells and so it’s opportunity to reoccur or to land in bones or other tissues is modern high. And I think anyone who gets a diagnosis of cancer should stay on some kind of treatment program for life . Especially change your diet. Seek to add alkaline foods and cut out the sugar and eat lots of green vegetables and high quality organic meats. My thoughts…

All of the Drs, nurses and staff diagnosing and treating my prostate cancer at 2 institutions have been caring, kind and genuinely concerned for me, and committed to the well being of their patients.

And I am grateful.

Correct me if I'm wrong :
I have never heard of HDR Brachytherapy as a 1st treatment for Stage 4 prostate cancer .
Sunnybrook Hospital , in Toronto , a world leader in Brachytherapy under Dr. Morton , a Center of Excellence for prostate cancer research & treatments detaaails the HDR & LDR options plus Brachytheerapy Monotherapy .
Google : Sunnybrook Hospital Dr. Morton Brachytherapy Video .

Hi Steve,
Yes, welcome to the forum. I had 5 weeks of radiation followed by Brachytherapy for Gleason 7 and 8's in 2017. I am currently 73. I had some troubles with the Brachytherapy about 4 months post placement where my Prostate swelled to the point where my urthera was blocked. I had emergency care to be opened up ( painful) followed by several months of self cathing. Please note, this was not done at Mayo Clinic. After that I had 6 years of low psa scores and few problems other that the need to urinate frequently. After 6 years I developed prostatic strictures at my bladder neck which where my gleason scores were the highest. I have heard that radiation is a gift that keeps on giving and over 2022 and 2023 I had 4 laser procedures done to open up my urethra. TUIP's, Balloon treatment etc. All of these actions worked for the short term but the strictures would reappear. I am now with a SPC. (Supra Pubic Catheter) and I have to say while not convenient is has been better than all those roto-rooter experiences. If I could have a do-over I would have waited after the 5 weeks of radiation to see how that worked before jumping immediately to brachytherapy. Too much radiation has it's own issues but at the time my focus was on ensuring we killed the cancer. I was not warned of these potential side effects. My PSA is still negligible. Best to you on your Prostate Cancer journey.
RJW