Looking for info on HDR Brachytherapy to ask Radiation Oncologist

I’m sorry, but I have no firsthand information about this.

Yes, I am. I remember reading about it somewhere; but your urologist really did you no favors by neglecting this test. With all I’ve learned about the shortcomings of PSMA scans, I put greater trust in the odds offered by genetic testing.

I am fairly certain all the different modalities can work; it all comes down to user preference and confidence in what they know best.
45 treatments does seem a bit old fashioned these days, but if this dr has great success with it, I would say to let him do his thing. But you should ask Dr Proton if he’s treating the nodes as well during his 5 sessions.

There is no such thing as a cure. Going into long-term remission is more like it.

If the doctor doing IMRT isn’t doing anything more than the prostate itself. I would not really think that It would be any better than the SBRT sessions. You say he is also going to treat the pelvic lymph nodes, still not an issue.

At the latest PCRI conference on March 29 a doctor was saying that the reason doctors are doing IMRT is because they make more money doing it than they make doing SBRT. Those extra sessions really add up financially, but they don’t really give you any extra benefit. They can do SBRT to the prostate and the lymph nodes in many fewer sessions.

If you look it up, you will find there are a number of things that happened after five or 10 years from the time radiation is given. Incontinence is only one of the problems..

I dealt with 3 top institutions and all had their procedures and protocols. Mayo emphasizes proton radiation that is a leading and relatively new methodology where they've invested a tremendous amount of resource in the machines that a number of other institutions do not have. I certainly considered treatment at Mayo for this reason, but, decided I could get similar results here in California with the other two major institutions that I was working with, both of whom had their own procedures and protocols that differed widely. The challenge is being able to determine what is best when the providers are not objective.

I was treated two years back as a 71 Year old male with NCCN unfavorable intermediate risk prostate adenocarcinoma -- T1c (T3a based on MRI) M0N0 ISUP Group Grade 3 (Gleason score 4+3; 4/14 systematic cores); initial PSA of 4.08 ng/mL; Decipher 0.57 intermediate. PET scan: negative.

After a great deal of discussion and research, I completed tri-modal: Orgovyx/4 months; 2x Cyberknife boost; 23x IMRT and now, thankfully, am in "remission". However, I was days away from having HDR Brachytherapy as boost radiation. What changed was that I met a friend who is a retired urologist and current CMO of a medical group. We were able to talk 'off the record' and he told me that two of his close friends had damaged rectums from HDRB, and while he fully supports that institution, he suggested that I look into alternatives. I was able to find another RO who had moved away from HDRB to Cyberknife as boost radiation and published several papers on the topic, one of which I have attached. Of course, avoiding general anesthesia and a catheter had an effect on my decision as well.

Best of luck choosing the right treatment for your case. MCC has been my other independent advisor and I am grateful to have all these wonderful sources of information!

Yes, I read that many times. Canada which doesn’t have the profit motive AND collects more and better data due to the centralized public health considers SBRT just as effective and have data to back it up. Thanks Jeff!

@robertov I know this post is old and hope you are doing well. Just was wondering what treatment you ended up doing?

Hi @copyman, I ended up getting Proton Therapy at Mayo in Phoenix. I was/am a Gleason 8 and was on Orgovyx. I spent almost a year on Orgovyx, during which I looked at my options. My original RO would only do IMRT 40+ sessions. Eventually I decided on Protons because of the way they release their energy at the ‘target’. I strongly would have considered HDR if I had researched it more.

I had my Protons in Sept 25. Went very well, it was easy to handle and the side effects were minimal and went away after a couple of months or so. I stopped Orgovyx in March ‘26 once I ready the JAMA Oncology article on the ‘Optimal duration of ADT’. I’ve felt great, especially as I’ve picked up my exercising again. I traveled to France for a couple of months after stopping ADT. Right now my testosterone level is back to normal; I feel really good. My 6 month labs showed undetectable levels of PSA. Keeping my figners crossed.
Thanks for asking. How is your journey going?