A few months ago, way back, when I thought my diagnosis was unfavorable intermediate risk prostate cancer, I found that this interview with Dr. Neil Desai, an eminent radiation oncologist at UT SouthWestern, was very helpful as I prepared for my first interview with a radiation oncologist: https://www.youtube.com/watch

The RO I saw after my intensive study of "unfavorable intermediate risk", straightened me out as to what my diagnosis was: I am “high risk”. So, I haven't researched much further into treatments suitable for your case. I have put in a lot of effort into studying what advocates for brachytherapy have to say.

Regarding what you were told, ie. “but either treatment will provide equal survival rate in my case”. If anyone told me that these days, I would be careful to find out precisely what the doc was talking about.

“Equal survival” data often or maybe even all the time, isn’t necessarily understood by patients.

Eg: let’s say treatment one results in a certain rate of the cancer coming back, with more and more failures as the years go by. And let’s say treatment two results in a much lower rate of the cancer coming back with less and less failures as the years go by. Because there are so many “salvage” therapies available that can keep patients alive when their initial “definitive” treatment fails, statements like “the two treatments offer equal survival rates”, can be, and are, made.

From my point of view as a patient, there is a big difference between treatments that have different rates of recurrence. One primary thing I’m looking for in a treatment is the highest chance of no recurrence during my lifetime. I do not view an alternate treatment that offers “an equal survival rate”, that has a higher chance of requiring salvage therapy or many salvage therapies, to give me this equal survival rate, as in any way equivalent.

Of all the docs touting all the different therapies that I’ve studied, it is only the brachytherapists who try to make this clear to patients.

Mira Keyes is a former president of the American Brachytherapy Society. She is very actively promoting brachytherapy. In one video: “Brachytherapy: The Royal Flush of Radiation Treatment for Men with High Risk Prostate Cancer”

“There's two men - they both die at the age of let's say 92.... ...One was actually the father of Peter Grimm… one of the fathers of modern brachytherapy.

Peter's dad in his early 70s got prostate cancer. He got brachytherapy and he was well until he died when he was 90. His very best friend also was diagnosed with prostate cancer in his early 70s. This man had radical prostatectomy which failed then he had salvage radiation which failed then he had a loads of different systemic treatments. He traveled around the world to find what would be acceptable.

At the end of the day both men died when they were in their early early 90s. Except that the friend of Peter’s dad spent from insurance money and his own pocket about two million dollars. [Compare: Peter’s dad never had any recurrence at all].

This is the difference we are talking about.”

A great discussion between brachytherapists is this 2022 LDR Brachytherapy Symposium video https://www.youtube.com/watch

PS. I lean toward HDR, especially if I had any doubt about the technique or expertise of the LDR practitioner. I like that with HDR the radiation source comes out after a short time in your body. They put in their tubes and to some extent if they aren't exactly where they intended to put them they can compensate by adjusting the rate the source passes by particular areas, so possibly less skill is required. I also don't like that LDR seeds sometimes are found elsewhere, like in your heart, or lungs. But the radiation is far stronger with HDR. If I had a choice between expert experienced LDR BT and HDR BT I wouldn't see a big difference.