Experience with combo Brachytherapy seed implants and EBRT

I haven't had that treatment, but I'll just add the caveat that any treatment choices really depend on your friend's overall health. If he is becoming more frail and has comorbidities like a weak heart, his onco team won't want to take aggressive measures and possibly ruin his quality of life for his last decade (or so); OTOH, if he's a 79-year-old marathon runner, they might treat him the same as if he were in his 50s or 60s.

Long story short, what others in this forum have experienced might not make sense for him and vice-versa. Hopefully you'll get some good information, and best of luck to your friend.

Dear Fisch,
I'm 10 years younger than your friend. My treatment for the same Gleason scores in 5 of the 6 biopsy zones has been: 25 EBRT, 17 stainless Steel tubes inserted into my prostate and a high intensity radioactive isotope moving and stopping for a period of time in each tube (my Doctor also has her PhD in Physics and is a tremendously hardworking Genius), and 2 - 1/4 years of Lupron shots (1/ 3months). It has only been 2 - 3/4 years since my diagnosis. My Testesterone has dropped to < = 12ng, and my PSA has dropped to 0.02! I have been taking a break (nearly 6 months now) from the Lupron shots as my joints ached and my fatigue was great. I anticipate that I will sooner or later return to the Lupron shots so that the adaptability of the prostate cancer cells will not kick in and become the most aggressive prostate cancer cells.
I also jogged marathons. I hate to break it to all of us...; Boys- those days are over! It's sad, it can be heartbreaking and defeastating, but we all need to get over it and adapt our brain and physicality and self-image to our current and long term reality. I no longer have the tremendous gifts of muscular strentgh, muscular endurance and aerobic capacity that had been granted to me for over 60 years. I would be lying to you and myself if I told you it's no problem. It freaks you OUT!!!! My forearms building up with latic acid just carrying groceries to the car in the parking lot!!! Having to sit down and catch my breath after taking a load of laundry up the stairs! Having to walk for 2-3 minutes to catch my breath after every 45 seconds of running / jogging!!!! And the loss of muscle mass, the increase of fat mass and the change in body image is an earthmoving change that each one of us will need to squarely face and stoicly deal with fortitude and persistence. But we are alive. Life has changed, our health has changed, our activities for personal meaning and enjoyment need to also change and adapt, but every Day IS a GIFT and rejoice in that amazing gift and in every breath you take, every smile you give, every prayer you pray for others. Best Wishes to you and your friend. God's Peace and Blessings to All in this Struggling World.

I am starting in a similar tri-modal regimen for 4+3=7 PC. I started: 1. ADT/Orgovyx about a month ago and 2. have my first 'boost' treatment next week. I chose SBRT/Cyberknife over Brachytherapy/HDR after hearing from a trusted urologist who is a friend, as opposed to the 5 other Drs. opinion that I received that were formal opinions and were influenced by their institutions, Stanford and UCSF. I was advised that HDR could cause rectal damage and, while all treatments have risks, SBRT was lower risk. I'm attaching a paper written by the Dr. who will be performing my 'boost' radiation. 3. Following the SBRT, I will receive 23x EBRT treatments.

There are multiple types of Brachytherapy. (HDR & LDR) are most common, but, you can check online for the full list. LDR leaves seeds implanted that can cause some risks to others, like grandchildren sitting on laps.

As already mentioned, every cancer is different, and it's best to avoid 'rules of thumb' if possible. My cancer is in a difficult position for surgery and all but one urologist, who is nationally known, advised radiation. The later Dr. spoke of the advantages of surgery, but, was overall neutral. I'm happy to avoid surgery and catheters, but in the end, we all want to pick the most effective treatment with the least side effects.

I still wonder if it's a blessing or a burden that my PCa paralysed me by compressing my spinal chord at T3 (before it was detected). It's a burden because, as I've mentioned in other posts, I was in a hospital bed for months; it's a blessing because over the two years since diagnosis, I've seen myself getting stronger instead of weaker (from admittedly a very low starting point, and with many temporary setbacks), and that's left me feeling optimistic instead of defeated.

Every first — the first time I was able to get upright (for a few seconds) with the help of a Sara Stedy then with support from my arms on parallel bars, the first time I could sit up for an hour in the wheelchair without getting dizzy, the first time I could transfer to the wheelchair by myself, getting home from hospital, the first time I cooked a meal from the wheelchair, the first time I could walk 100m outside with the rollator, then with a cane, then unassisted — has felt like a victory.

It was easier for me to feel that way because of my situation, but I wish everyone with prostate cancer could see the victories they're winning every day, even when things look gloomy.

Dear Noth of the Border,
You are a CHAMPION Brother!!!!! Keep on Keeping ON!!!!

You are fantastic! Keep getting stronger!

Thank you both for the kind words, and please remember that even if they're less obvious, you're both winning victories all the time too. Cancer is the toughest challenge most of us will ever face, and getting up to greet each new day is a triumph worth celebrating (@weakbutstrong 's handle captures that perfectly).

Thank you so much for taking time to respond. I truly agree with you that every day is a gift. It is difficult to decide on a treatment plan when several doctors are involved, and each has a slightly different take on things. My friend is in good physical condition for his age...walking every day. As you say, he needs to be prepared for life to change. Nevertheless, we are all blessed.., and I wish you the very best. Many thanks again.

God Bless you All.
Your friend needs to make HIS OWN DECISION! Not the Doctors, they consult and know their Art And Practice, but He needs to fully, totally and unreservedly make that/those decisions so he is empowered by the decision and interventions; so when things change in His Life he knows it was and is his choice, what he thought and decided what was best for his function, health, family situation, relationships, longevity, sexuality, etc., whatever factor / factors are most important to him. Rather than, in his mind, saying, "Oh, Dr. So and So gave me the wrong information. I should have never done that!" And decreasing his energy and vitality, his gestalt to fight and to live. Good Luck. I know you will make the right decision for you! I know I made the right decision for me and my wife, I choose longevity over all other factors. I may not be happy with some of the losses I have had to, we, have had to undergo compared to our earlier (pre-pc) life, but the choice was mine and mine alone, and that is a good thing, in my mind and in my being. May your choice empower you throughout your lifespan. God Bless you and our Struggling World. And Many Thanks to all the Doctors and Researchers who's sacrifices, efforts and disciplined lives continue to improve our lives!

Trying to respond favorably to the Seed Implant surgery, which I had back in 2003. We didn't follow up with any further treatments. Today, at age 82 soon 83, my PSA has reached 16.7 compared to 14.1 back in 2022. We plan on a Pylarify PET Scan and PSA in 3 months before counselling the next step. I wanted to "wait & see" back in 2003 with a PSA of 2, but was convinced that was not a good choice. So, who knows for sure? I had a friend, 84, with PSA of
over 20 that finally had a procedure he said to "pump him out". Says he is getting along just fine.
Good Luck on whatever you do. The people working on you know a lot more than you can comprehend.