My Treatment Decision Is In: Single Seed Brachytherapy

@paul28 It's my first time hearing about the use of radiation within the prostate ported to various locations with tubes. Googling, I see a few descriptions including this one on the Mayo Clinic site https://www.mayoclinic.org/tests-procedures/prostate-brachytherapy/about/pac-20384949
Given your complicated history, I can see why this approach might be particularly attractive for your treatment plan. Here's hoping for meaningful outcomes!
So traditional brachytherapy is now LDR (low dose radiation, I think) and this approach, apparently also used with some other cancers, is HDR (high dose radiation, but maybe we should add VT--very temporary?!) What an interesting approach to ablation--killing the cancer in place.

Thank you so much !
I do think that there is more to learn about this treatment.
My Urologist will actually do the surgery that will implant the needle tubes.
My Oncologist, ( I actually have a team of 5 involved ), will do the actually prostate radiation.
There are also scans involved prior to and immediately following the procedure.
It is somewhat more going on than what my description would indicate.
So we will see!
PAUL

@paul28

Have you had a discussion about the type of external beam radiation therapy machine they are going to use on you and the associated margins as the greater the area of healthy tissue exposure the more potential side effects?

You can request they put in a hydrogel spacer to protect your rectum. They put it in with a needle and it evaporates into your body and comes out in your urine as it deteriorates. Also called SpaceOAR. Some radiation oncologist, swear by it others don’t want to use it. You need to ask your radiation oncologist.

Frequently it is put in by the urologist but some radiation oncologist want to do it because they feel they have a better feel for it.

Brachytherapy is a pretty common procedure and is successful for many. With a Gleason 9 recurrence is common, after a few years, get regular PSA tests. There are many more treatments in the future, if you need them, that will keep you living for a long time.

A leading Radiation Oncologist a Dr. Morton at Sunnybrook Hospital Toronto , A Center of Excellence for Cancer is a world leader in HDR & LDR Brachytherapy . Many of his reseearch discoveries are also used worldwide .
He has a series of youtube videos of his work .
Basically HDR High Dose Radiation is the one where theyy remove the seeeds . LDR Low Dose - the seeds remain in place . They also perform Monotherapy Brachytherapy 2 doses 2 weeks apart . No hormone treatment etc. afterwards . This is more for Gleason 6 and selected Gleason 7 ( 3 + 4 = 7 ) patients .

The actual machine itself, no. Not really sure.
I can find out though.

I have asked about the Brachy as a monopoly!
I was disappointed when told that my Gleason 9 ruled that out.

Absolutely.
I have specifically asked for the gel spacer.
I was told by a team member that my doctor doesn't like to use it.
I am going to find out if my Urologist can be involved with getting this done.
Everything you have said is absolutely true about these things.

I don't know about this procedure but I had the gel spacer. It was a bit uncomfortable for a few days but I had no rectal issues whatsoever from radiation, which ended almost four months ago now. In fairness, I don't know how long such issues could take to show up but my radiation oncologist said it is rare to get a late side effect that one didn't have earlier, i.e. my urinary issues could possibly return at some point but it's unlikely I will get brand new rectal issues down the road.

@scottbeammeup
Thanks for your response!
I am still working on getting something pre-planned and agreed to concerning this issue of protecting the rectum.

It is difficult for me to process that my Oncologist "just doesn't like to do it".
Life is all about doing things that we don't like. I don't like having cancer but I have stepped up to do whatever is necessary regardless of my comfort level.