Faced with a treatment decision: Brachytherapy vs high dose radiation?

I am very different than most patients. I am 74 and my research of articles and combined with my symptoms which were just a 7 mm lesion that tested 4-3 and 3-4 from only that area of my 120-gram prostate and 30 cores of my biopsy, and a 2.9 PSA showed that ADT made no difference in BCFS or overall survival due to being over 70. That being said I have been on testosterone replacement since 2008 and when I stop applying the Androgel I go castrate in two days. My radiation oncologist still wanted to jab me with Lupron and did not believe me even though I had the bloodwork to prove it. He had me tested and my testosterone level was 12 ng/dl which is lower than a six-month Lupron shot. I did stop the testosterone before my radiation just to hedge my bets. I consulted with a urologist at Mayo, and he will prescribe testosterone when I decide to start again and use up what I have at home. The reason I have not started back yet is that it has been so hot here in Phoenix this summer. I have a pool and I really like being able to jump in anytime I want to. I could take the shots and did that once when I went on a scuba vacation, but the injection site pain took over a week to go away just in time for the next shot. Fall and cooler weather should be here sometime from the third week in September on. If you need the article about no advantage of being over 70 let me know.

I had HDR (high dose rate) brachytherapy. The other type is LDR brachytherapy, which plants permanent seeds with a short (months) half-life. I went with HDR because of the risk that the LDR seeds can move around. HDR is very targeted, putting radiation only where needed. A computer is used to deliver the short-term radiation and then the material is removed. It is the most invasive, after surgery, but still an out-patient procedure. You have to do it at least twice, often about a week apart.

I had the HDR done at Mayo in Rochester. Side affects consisted of fatigue for 3-4 days after each of the treatments. My radiation oncologist had me start flomax the night before the initial treatment and I was on this for 5 weeks. Did have some mild urinary symptoms during this time but nothing severe. I did develop ED which occasionally happens but this is improving. I was able to return to my regular exercise routine within a week of each procdure and 2 months after treatment I went rafting and hiking in the Gates of the Artic NP for 2 weeks.

My initial treatment was LDR bachy, which worked about 5 years. When the PSA & Gleason crept up I had HDR salvage therapy which was a complete bust right from the start. To be fair, the radioncologist from pictures he took told me that the entire prostate was riddled with cancer. In addition, he nicked the urethra with caused all kinds of stricture issues that kept my Urologist busy.
Put me in the LDR brachy camp, which does have about a week of down time associated The HDR recovery is shorter, but like any medical procedure, if it doesn't go perfectly the recovery goes on for years, about 6 for me.

Yes. I had brachytherapy in 2017. Gleason 4+4 Left lateral base and 4+3 left lateral mid. After initial treatment I had swelling of the prostate that lasted about 3 months and had to self cath. Had 5 years of no problems following that but starting in 2022 stricture development occurred in my urethra. I have had 4 treatments (Laser surgery, TUIP etc.) in the last year to address this issue but have not found a permanent solution. I do not believe there is one. Most recent procedure was the Optilume balloon process with chemo drug to mitigate the formation of strictures. I guess all radiation can cause these issues but certainly not a good side effect of the radiation. Hopeful the balloon treatment will give longer term relief.

I too was treated in 2017 for a Gleason 8 case of PC at a specialty clinic in Florida. Treatment began with Androgen Deprivation (Hormone) therapy followed by about 40 daily treatments with direct beam radiation, a short break and then brachytherapy. About 110 radioactive seeds were implanted of a specific design unique to this clinic and then several months off, followed by a touch up radiation of about 10 treatments.

Since then I have been largely free of the most bothersome side effects and semi-annual testing (PSA undetectable) supports remission for now five years.

I wish you as good an outcome.