@heavyphil
At the Rochester Mayo I had the option of HDR monotherapy or proton which would have been 5 treatments over a 2 weeks. There are not of many RO trained in this procedure and I am assuming it is very expensive to set up the equipment and staff it. The treatments are set up 2 weeks apart and they need to put you under. Most people do not want to be put under and choose the proton. For me I chose the HDR Brachytherapy to reduce the travel.

@heavyphil

I have not made a decision on when and how to treat. Initial biospy last year was gleason 3+3, but with a 2cm pirads5 lesion.

The radiation oncologist has recommended HDR brachytherapy (2 sessions), if I choose radiation. She feels this is a very good option for myself. She said they did not use spacer gels (at this time). Their studies/experience indicated the spacer gels with HDR were either not helpful or worst case, interfering with the radiation.

The RO has been very diligent in looking at my information and not just checking “boxes” during appointments. Decipher score came in about 3 weeks after initial consult (based on MRI and biopsy).

She reviewed Decipher score of 0.48 and had me come in for another consult. We discussed continued active surviellence, but the need to be watchful with a pirads5 lesion and mid-range decipher. She then arranged for a PSMA petscan. After petscan did not show any activity outside of prostate, she indicated:

Two sessions of HDR was still her recommended radiation treatment.

If I was approaching 70 years of age (just turned 61), HDR would be the most attractive treatment. This is from my current studies/knowledge.

Best wishes.