Low dose brachytherapy long term side effect risk

Posted by havhav @havhav, Nov 4, 2022

My 55 year old husband has Gleason 7 (4+3) posterior peripheral T2a prostate carcinoma with PSA 5.2. 1 ml more or less volume tumour. PSMA pet scan did not show evidence of spread (we realize this can be false negative). We are trying to make decision on radical prostatectomy versus low dose brachytherapy as those are the two options most recommended for him. He is trying to chose and one big focus he has is on the long term side effects that will affect his general quality of life. Obviously if treatment not curative and further therapy with radiation, etc is needed then that is separate issue as we were told cure rates are similar for both RP and LD brachytherapy for his type/size of tumour.
Long term urinary risks present with both options however surgery more likely to be urine leakage issue whereas brachytherapy’s long term urinary risks appear to be more urgency, reduced stream/outflow, perhaps pain or bleeding from radiation induced cystitis. Rectal inflammation risk present long term with brachytherapy, not with surgery. Erectile dysfunction appears to be worse outcome with surgery than LD brachytherapy long term (I believe long term risk equal with external beam versus RP but less with LD brachytherapy, is that correct)? Very tough decision to make. He is reportedly a very good candidate for either surgery or LD brachytherapy. So comes down to this vague feeling choice based on perceived risks and if one of the lower chance long term side effects does occur, how manageable it will be. Just wondering if anyone has thoughts or more info on outcomes or how to make this choice. Are there statistics out there? Or are risks so individualized to age, tumour characteristics, general health etc that no further info out there to help. We seriously feel like we are in a coin flip situation . . . kind of scary . . .
The other info is that surgery can happen in 10 days whereas 2.5 month wait for brachytherapy locally then the tumour damage/control from it occurs over the following six months. That delay must increase risk of spread . . . not sure if the time delay significant for a Gleason 4+3 or we shouldn’t worry about that factor? Biopsies were back in beginning of September . . .

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newyorker60 | @newyorker60 | Jun 18, 2023

I felt obligated to weigh in here even though those involved may already have sought their treatment--and I hope successfully-- since I had low-dose brachytherapy 18 months ago (at age 60), and I must give it equal time.

I didn't even consider surgery after looking into it, and after speaking with oncologists (more than one), my urologist and a surgeon. The possible longer term side effects just seem greater and outcomes for favorable intermediate (3+4) were the same. I didn't require ADT with radiation. Having few past urinary issues and being favorable intermediate, catching this early with a PSA of 5.75, made me a good candidate for LDR brachytherapy.

I was very lucky in that I didn't have even much that was noticeable in terms of short-term effects. The first few days following treatment I had the expected burning but it subsided. I had no urinary frequency in the early days and weeks (as most others seem to), possibly because I had no urinary issues before. I stopped taking flomax within weeks. Was sleeping through the night from early on, without getting up to urinate.

Had no gastro or rectal issues, no prostatitis, no problems with ED or sexual function. My PSA dropped dramatically at the 4 month mark and continues to remain low, now at 18 months out. Life has gone on, including sexual life, pretty much as it was before. I have spoken with many others who've had the same outcome. Sure, just as with every treatment, there are those who had more adverse effects. As has been stated, everyone is different.

Just please don't dismiss this one-and-done, minimally-invasive treatment which often has minimal effects if you are candidate for it.