Experiences with HDR brachytherapy....

Here is a lot of information

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/
See all: https://connect.mayoclinic.org/group/prostate-cancer/

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/

See all: https://connect.mayoclinic.org/group/prostate-cancer/

HDR Brachytherapy is being done with great success at all the Centers of excellence. As a matter of fact most centers are not doing LDR Brachytherapy (seed implants) anymore and only do HDR Brachy. Some HDR Brachy done as mono therapy as you are having and some done with EBRT / SBRT. ADT is added to treatment depending on each persons stats. Someone with 3+4 like you mono HDR Brachytherapy has shown very good results. Also several studies are being done with HDR brachytherapy and various combos, i.e. whole pelvis region RT, length of ADT, etc etc.
Wishing you the best with your treatment.

ltr @ltr It is good you are reaching out, surprised you have had no response. I am 6 years into PCa, after a few years AS, about 3 years ago I did Tulsa Pro, then I had a recurrence this year. I evaluated locally to me a really good HDR brachy program for that recurrence. I was real impressed with program here, they are building top notch doctors and techniques. I was eliminated from that in the end from HDR because public arch interference. But I learned some things. Top notch docs don't need to add any form of external beam: they can see tumor, they can target it, they can kill it. Provided no pubic arch issue, or, size of prostate issues. Because I was eliminated from HDR here in my hometown, I went to Mayo Dr Woodrum in MN who did cryo-ablation which he uses for recurrences post Tulsa Pro. I think it depends on location of your issues, seminal vesicles and ejaculatory ducts when damaged result in dry orgasm. And maybe not always, I don't think there is any one answer on that question area. I did not get urinary issues with Tulsa Pro or cryoablation, location again factors into it, and if they want beam added.

I hope you get more answers, but brachy is good, but restrictive on who can have it I guess.

My case is more advanced that yours. 4+3=7, cT3b. I had HDR at Fred Hutch. They gave me one treatment prior to 20 sessions of IMRT. I can't say if it caused ED because the Orgovyx the RO had me on for several months prior to the HDR wiped out my libido and I haven't had an erection since. He wanted me on Orgovyx prior to anything to shrink my prostate so he would have a better chance of success with the HDR. I'd say the HDR caused me no side effects at all.

I had a big crash after the 20 sessions of external beam ended. I think all the stress of being diagnosed in the middle of moving to a new town, figuring out whether the staging was adequate, what treatment to accept, undergoing the HDR, then the 20 sessions of external beam treatment and ringing the gong they had at the radiation facility when I was done added up and when I got home I had extremely low energy and severe diarrhea for several weeks which extremely slowly declined over many more weeks. I feel restored and normal except for the side effects of Orgovyx now. My urinary issues have improved. The RO said shrinking my prostate might do that.

I can set my mind to undergo extreme hardship, and endure for weeks or even months, but at some point, I crash. There's been a few times in my life like that .

I've heard HDR side effects compared to LDR usually hit earlier and end earlier. Highly skilled clinicians tend to be more important than with external beam. I was treated by the chief of brachytherapy at an NCI designated cancer center, Fred Hutch in Seattle.

Also Dr Chang at UCLA is one of the best HDR Brachytherapist in the US.

Low-dose-rate brachytherapy (LDR-BT), a/k/a permanent seeds, is increasing in Europe. It used to be 17% in the USA; now it is down to 7%. What is the disconnect? I suspect fewer are trained at all, or to an acceptable skill level, because of financial disincentives. However, the research suggests that the optimal dose (misnomer 'low dose') of radiation can be best provided over weeks to a month by the placement of interstitial titanium 'seeds' containing an isotope that decays over time. External-beam radiation advocates even talk about 'boosts' with brachytherapy. Why? An external beam, by its very nature, cannot safely provide an optimal killing dose. Only an internal short-range 'beam,' as in LDR-BT, can safely achieve it. It does not travel through healthy tissue to reach the target lesion(s). An instructive source on this topic is a YouTube video produced by pcri.org entitled 2025 ASCO (American Society of Clinical Oncology) Abstract / Poster 388. More info on LDR-BT and HDR-BT (brachytherapy) is to be found at pcri.org site.