Brachytherapy

Unfortunately, you didn’t supply any information about your biopsy, your age, and any other metastasis issues in your body. Have you had a PSMA PET scan?

It’s hard to comment without more information.

Brachytherapy Is heavily used in Europe and is very successful, Not as many doctors are doing it here. Frequently they combine it with IMRT radiation, but that depends on the extent of the cancer.

I was seriously considering triplet therapy (HD brachy to the prostste, IMRT around it, plus ADT) after my Gleason 8 biopsy diagnosis. I opted for surgery after it became clear that my cancer was still very likely contained to the prostate and that at least partial nerve sparing would be possible. I was 51 at diagnosis. For me, the deciding factor was that ED risk with this approach would have been higher than with surgery only. Had there been a high risk of my needing adjuvant/salvage post-surgery, I would have opted for the triplet therapy.

One thing to keep in mind is that for radiation therapy experience is as important as for surgery. My PCRI oncologist told me that the radiologist should have done at least 300 treatments to the prostate.

@jeffmarc I'm 69, Gleason 4+3, localized, 28cc prostate, no Decipher score as yet. Just had a clean PSMA scan.
It seems that in some analyses HDR-BT monotherapy had competitive results with triple-mode therapy. That seemed attractive to someone not yet decided on ADT. And it is claimed BT delivers a higher dose to the tumor while sparing healthy tissue.

@bob1955
People have triplet therapy when they have metastasis outside the prostate. That’s because they cannot be treated by just treating the prostate. Chemo is the third therapy.

Brachytherapy Is designed to treat the prostate not Designed to treat metastasis outside the prostate. In that case they would do IMRT Or SBRT on the metastasis outside of the prostate, if there were not too many.

HDR-BT Is very effective to treat prostate cancer that is isolated the prostate.

I'm very interested in brachytherapy (BT) as well. I'm going to ask my RO for his reasons why he did not mention it as he laid out his plan for 20 days of EBRT plus 2 years of ADT. The two urologists I consulted also did not mention BT as a possibility as they gave me a choice between surgery and EBRT.

The use of BT in the US has been declining for years. Yet in Canada, and the UK, its use continues to expand. BT providers are saying studies prove it can be used in a wide range of cases, and especially when used as a boost in high risk cases, it can deliver superior results with less ADT required, meaning higher quality of life.

Mira Keyes, President of the American Brachytherapy Society, suggests several reasons for the declining use in the US. compared to what is going in other jurisdictions in this talk: "Brachytherapy: The Royal Flush of Radiation Treatment for Men with High Risk Prostate Cancer", available on Youtube.

One of these reasons is that in the US for profit health care system, it is harder for brachytherapists to survive financially, compared to if they were providing other forms of RT. She pointed to the October 2019 Nature issue that had a series of articles on Brachytherapy. One those articles "Keeping Treatment Options Open", noted that in the US, because of the rates of Medicare reimbursement for BT, providers made $400 per patient, whereas IMRT providers made $4200 per patient.

She discusses BT and ADT in more depth in "Treatment of Prostate Cancer: Androgen Deprivation Therapy (ADT) and Radiation with Dr. Mira Keyes" also on Youtube.

One explanation of BT that I found useful is Beam Radiation Vs. Brachytherapy for #ProstateCancer" on Youtube.

Apparently, Seattle and Vancouver, B.C. have played a significant role in the development of brachytherapy over the years, which has resulted in high quality providers in these cities.