Brachytherapy: What to expect for short and longterm effects?

@climateguy I agree that your best option is HDR-B used as a boost combined with 20 sessions of EBRT. When fewer high dose sessions of radiation (usually SBRT) are used for the lymph nodes and greater pelvic region, there are high risks of toxicity from that protocol. I was almost entered into a trial like that and later found out the trial was aborted early due to radiation toxicity issues. See my bio for more details.

Here are a lot more messages related to brachytherapy

There are several discussions related to brachytherapy for prostate cancer, including these:
- Brachytherapy? Anyone have thoughts?

https://connect.mayoclinic.org/discussion/brachytherapy-anyone-have-thots/
- Immediate Side effects of Brachytherapy

https://connect.mayoclinic.org/discussion/immediate-side-effects-of-brachytherapy/
- Brachytherapy: Regrets & Why ?

https://connect.mayoclinic.org/discussion/brachytherapy-regrets-why/
- ADT with EBRT and Brachytherapy
https://connect.mayoclinic.org/discussion/adt-with-ebrt-and-brachytherapy/
https://connect.mayoclinic.org/group/prostate-cancer/

@wwsmith That’s interesting. When I had my SRT at Sloan, I met two men who were having HDR plus 5 Cyberknife sessions…wonder how they’re doing now?

HDR-B and LDR-B are good distinctions. Brachytherapy is often mentioned without describing which type.
HDR-B is expensive LDR-B is much less expensive. Few places offer the LDR-B for lack of training opportunities.
Adding time to the radiation equation of weeks or months allows consistent slow irradiation inside the prostate
which gives the optimal dose. HDR-B typically requires two visits separated by a week. LDR-B is one and done
and time. To make up for the high dose radiation lobby consider watching the You-Tube video entitled
Brachytherapy-101. The guest presenters were chosen by the PCRI.org (Prostate Cancer Research Institute).
They don't overlap in all circumstances .

@heavyphil In those early trials on using SBRT like IMRT for wide area low dose applications, my understanding is that they were being very ambitious on the radiation dosage and experienced toxicity so early in the trial that it had to be aborted. Over time, I am sure that this has been worked out such that SBRT can be carefully used for low dose wide area applications. You can read more on those early trial issues here https://www.inspire.com/groups/zero-prostate-cancer/discussion/5636b1-anyone-used-tulsa-focal-treatment/

@thmssllvn at this post by @climateguy you can read how HDR-B was considered better on several points over LDR-B, https://connect.mayoclinic.org/discussion/brachytherapy-2/

My summary of that post is below.
Concerning the efficacy of LDR boost vrs HDR boost, they "strongly" concluded efficacy was similar, based on "high" quality evidence.
As to the toxicity of LDR boost vrs HDR boost:
Their conclusion was "strong" that "Acute urinary toxicity may be lower with HDR compared with LDR; long-term urinary toxicity is expected to be similar", but they said they believed their evidence was "moderate" for this conclusion.
On bowel toxicity: "Strong" conclusion: "Acute and long-term bowel toxicity may be lower with HDR compared with LDR" based on "moderate" evidence.

...Thanks, I could not 'drill down' at the hyperlink provided to the read the details pointing to the studies highlighting the subjunctive use of MAY and the level of evidence of MODERATE. Without having yet read the underlying studies for the basis of opinion in the hyperlink forgive my initial opinion. 'Boost' brachytherapy after external beam radiotherapy (EBRT) suggests that the reverse sequence might render a better outcome? EBRT by its passage through external healthy tissue must be suboptimal radiation. The one two punch might best be Interstitial with EBRT 'boost' if needed. The institutional juggernauts cannot be neglected in the considerations of the chosen study design. It would seem completely logical to use optimal dose radiotherapy followed by suboptimal 'boost's. A newer test, e.g., ProsTox ['MiraDx'] can reduce (at least) the DELAYED urinary tract symptoms risk for either SBRT /IMRT. The results are LOW or HIGH risk. LOW risk is 1-5% based on the skill level and technology used. The test does not relate to either brachytherapy presumably by virtue of the fact that the radiation is confined to the prostate and depends on the skill level of the provider and the level and quality of the visualization. [US/CT/MRI] If the original tests which MAY have given the nod to HDR-B with sufficient numbers for randomization the risk for DELAYED symptoms merit more weight. Multicenter studies beg the question of the skill level of the LDR-B providers. MSKC (NYC) uses CT and MD Anderson Houston uses MRI for intraprocedural visualization comparable to HDR-B. One group on the west coast uses ultrasound but has done 5 to 7,000 procedures.