Brachy therapy or Prostatectomy?

Welcome to the club no one wants to join!
Such a tough call. I can only tell you what was in my head when I made my decision....

I was told that if you opt for radiation, and there is a recurrence, you have already damaged the area somewhat with the radiation. This makes the Prostatectomy, if it's the next step, more difficult and complicated. Now the surgeon is operating on somewhat compromised tissue at that point.

As it turned out, I did have the Prostatectomy, there was slight invasion of nerves and capillary tissues found on the post surgical labs. I had to go into salvage radiation and ADT meds when my PSA started to rise shortly thereafter. Now I'm at PSA undectable and off the meds (treatment holiday, yay!)

It's just one of many factors in the decision, it depends on what your priorities are. I'm that guy who wants a good back up plan.

Best of luck to you!

Likewise, Welcome to this awful club. I am 60 I had my RP in early May and am almost finished with the PT/Pelvic floor training. I have almost no Incontinence and am slowly regaining my ability to have erections and somewhat normal sexual function. My PC was contained within my Prostate and I was given the same options as you. I have my first post op PSA test in August and if my PSA drops to some factor of 0.00 I will be declared Cancer free. If not then I go for further treatment with Radiation and Chemo. The RP was suggested instead of Brachy therapy/ADT, because both my surgeon and Urologist said that if I did the Brachy Therapy first it can damage the Bladder, pelvic floor and lead to long term Incontinence.

I was also a Gleason 8 (4+4) type 4 and after my RP It was down graded to a Gleason 7 (3+4) type 2.

This forum is fantastic and you are in the right place to ask these type questions. Ask lots of questions! 🙂 all of us have different perspectives and I feel lucky to have found this forum.

You have to send the biopsy slides out to check the grade, anything with a grade like that needs to be re-checked. It is your life.

Even with a small 8 and no spread, I had Tulsa Pro, it is another option.

New to the club. Gleason 7 (4+3). Leaning towards RP, as my father did not and it was miserable. 64 y/o in good health otherwise.

It was already mentioned that you should get a second opinion on the biopsy. You could do that at Johns Hopkins. Also, get a decipher test. It’s a tough decision and you want all the information you can get.

Also, get second and third opions at a center of excellence. Ideally also from a medical oncologist.

Your decision will likely also depend on the number of 3+5 cores, the overall number of positive cores, if cribriform or IDC is present….

Does your urologist say that with 3+5 the cure rate is similar to radiation with surgery only or did they factor in salvage therapy? If the latter, radiation as first line treatment might be preferable.

I was diagnosed at 62 with a 3+4 Gleason score. After surgery, they said it was a 4+3. Still here at 77 even though I have BRCA2 which prevents cancer repair.

You have a serious case, But unfortunately, you haven’t given us enough information.

The rest of your biopsy is as important as what you’ve told us about your Gleason score. Was anything else found? Maybe you could post the full biopsy results and we could review it.

I would not be surprised if you had a prostatectomy and they found that you were really a 4+5 not a 3+5.

A Gleason 8 calls for At least 18 months of ADT plus surgery or radiation. If your biopsies shows certain things like cribriform then surgery May be preferred, Radiation plus brachytherapy will do the job as well.

You need to speak to both the radiation oncologist and a surgeon to find out why one would be preferred over the other for your case. The oncologist can help with us as well.

@kazszs
There are multiple radiation choices and was curious how you and your doctor chose brachytherapy as one choice and removal as the other.

I had 4 + 3 = 7 and 7.1 PSA and wanted no part of RP. The side effects and lasting complications of the surgery were enough to scare me away. I chose a three part treatment plan at a major center of excellence in the southeast. My program was 23 IMRT sessions followed by one high dose brachytherapy procedure (they call a "boost") and six months Orgovyx hormone suppression. Very few, if any, side effects of radiation and very pleased with the treatment. Going back for first PSA test late July. Fingers crossed my PSA is much lower

Helpful Lexicon: BRACHYTHERAPY: HDR: High Dose Radiotherapy (temporary) AND (permanent) aka SEEDs, aka interstitial radiotherapy ('IRT' 'MayoSpeak'). 'RADIATION': External Beam Radiotherapy (EBRT). The latter includes SBRT, [stereotactic beam radio therapy] < 5 sessions of a higher dose, ideal candidate
are in the intermediate group favorable and unfavorable G7 {3/4, 4/3}. IMRT, (Intensity Modulated Radiation Therapy) is another computer generated earlier technology of lower dose over 20-40 sessions. Recent research suggests moderated (fewer) IMRT sessions are equi-effective as the traditional greater number. Apparently unlike other bodily tissues the Prostate is more sensitive to all forms of radiation. Adding neoadjuvant ADT (androgen deprivation therapy) increases that sensitivity by 67%, (There is some thought that adding Nubeqa brings the sensitivity to 100% of the baseline?) SYSTEMIC (Intravenous) 'radiotherapy' The most common prostate cancer can be targeted by the immune system loaded with a radioactive isotope (ligand). The first of several in the pipeline is PLUVICTO (PSMA Lutetium 177). (It is a 'first cousin of the substance in a PSMA PET-CT scan) Some well off individuals are resorting to medical tourism, going to Germany, India etc. to get the infusions of PLUVICTO. Currently it is not being used for cancer solely found in the prostate. I suspect ultimately systemic ligand radiotherapy will be available for non metastatic disease.

I am puzzled by your comments

“ The first of several in the pipeline is PLUVICTO (PSMA Lutetium 177). (It is a 'first cousin of the substance in a PSMA PET-CT scan) Some well off individuals are resorting to medical tourism, going to Germany, India etc. to get the infusions of PLUVICTO. ”

Pluvicto has been available in the United States for years and is FDA approved and paid for by insurance. Actinium-225 Is what people are going over to Europe to get infusions of since it is not approved in the United States. I know somebody that actually went to Austria to have it done.

“Adding neoadjuvant ADT (androgen deprivation therapy) increases that sensitivity by 67%, (There is some thought that adding Nubeqa brings the sensitivity to 100% of the baseline?)“

I have looked into this and find that the percentage vary a lot Based on the case. Where did you get the information about ADT increasing sensitivity by 67%? I’d like to be able to quote that information and also the addition of Nubeqa.

What I have read is this

“ In summary, ADT enhances the effectiveness of radiation therapy however, the exact magnitude of the improvement varies depending on the specific clinical scenario.”