I was diagnosed earlier this year. I'm 76. My PSA had gone from just below 3 to near 7 in one year. The digital rectal exam seemed normal. The MRI report was "PI-RADS v2.1 score 5: clinically significant cancer is highly likely to be present.... Bilateral seminal vesicle invasion seen", although there were no other indications of spreading outside the gland. The biopsy showed: Grade group 3, gleason 4+3, seminal vesicles involved, cT3b.

So, some of this sounds like you.

I have been treated with photon external beam with an HDR brachytherapy boost. I decided I would prefer this combination as appears to give the best odds of the longest recurrence free period. I liked the sound of a long recurrence free period or cure, compared to a long overall survival.

The "industry" seems to think if two treatments tend to produce equal overall survival times the treatments can be described to patients as giving roughly equal results. A patient who has surgery then salvage SBRT radiation then lifelong ADT then whatever the latest last ditch treatment is by then who lives as long as another patient who is treated and cured and dies after about the same time are actually said to have experienced treatement giving about the same result.

Many doctors in the US seem to think brachy is obsolete, or more dangerous, or that external beam RT is now as good. Dr. John Sylvester gave a presentation at a symposium in 2024 rebutting all of this that I found convincing.

External beam with brachy boost also appeared to me to have the best chance of allowing safe reduction of ADT time compared to any other treatment aimed at a long period of freedom from recurrence. Dr. Nelson Stone presented convincing arguments at that same symposium about this.

I did my best to figure things out prior to actually being treated. In retrospect I was stumbling around in the dark. Now that I've had the 20 sessions of external beam and one session of HDR, I don't regret the choice. I feel there was a lot of luck involved.

With radiation, apparently there are acute side effects, and later developing ones. I've made it through the acute side effects. Things went differently than I expected though.

I was amazed there was nothing that bothered me after the HDR. Supposedly the acute side effects of HDR can be a problem. I braced myself for that.

But I crashed after finishing the 20 sessions of external beam. The fatigue surprised and depressed me. I looked and felt many years older. When I did manage to go out I'd see a lot of very old people shuffling around looking like life was a burden. (I live in a town where 45% of the population is retired geezers). I realized, that's what I look like now.

All food tasted horrible. I lost about 5 pounds really fast, until I started forcing myself to eat even if I could barely keep it down. When I breathed out it felt like my lungs were expelling something bad. Diarrhea was bad. My butt got so sensitive I dreaded taking a crap. It was painful even to use a bidet. Resting did not improve things, no matter if I stayed inactive all day.

After about a week I could feel a slight trend towards improvement. Each day from then on I'd feel just a bit better. I'm back to what I was prior to the radiation now - a bit more than a month later. Improved LUTS, no bowel symptoms at all, energy level good and still improving, great mental outlook. When things are as bad as they were, it feels wonderful to come back to life.

So all is good. I'd go through this again, no problem, for the chance of a cure the data I looked at shows.

My improved urinary symptoms are probably due to the treatments reducing the size of my gland. It seems also due to the fact the operators may have managed to avoid blasting anything that would have made things worse. I had a rectal spacer.

I thought it might be better to have some sort of procedure to improve urinary issues prior to radiation treatment. Many docs advocate this. Mine did not. There are tradeoffs with anything the docs do. I went along with not doing anything.

My radiation oncologist is the chief of brachytherapy at Fred Hutch in Seattle. Fred Hutch is the closest NCI designated cancer center to where I live. I came to trust and respect him, which helped me accept what was happening to me a lot. I felt he placed a very high priority on doing the least damage to his patients while giving them the best chance he knew how to give.

He used rectal ultrasound to guide his HDR. MARS sounds better. With brachy I think it is more important to have the most experienced clinician doing the work as opposed to if they are using the latest equipment. If you've got a doc you like who is using MARS that sounds ideal.

My doc also supervised the photon external beam. The facility has an Ethos Hypersight which is a fairly new design that uses cone beam CT. It has some ability to modify the treatment plan on the day, and apparently it can shut its beam off if it is set to do so if it detects the target has moved. MRI sounds like an even better imaging system for this type of thing. I liked the sound of MRI-Linac, but I would have had to transfer my care out of state.

What I had no idea about was what an assembly line process external beam treatment is. You'll see. The operators of this machine at this facility were aiming to treat patients every 15 minutes. Compromises are being made. I have no real idea what they are. The operators deal with the fact they know what they do is not perfect by consoling themselves, if they've been around long enough, with how much things have improved over the butchery and mayhem they know has gone on in the past. I'll find out depending what long term side effects I develop.

2024 Southwest Prostate Cancer Symposium https://grandroundsinurology.com/scottsdale-prostate-cancer-symposium-2024/