Brachytherapy? Anyone have thoughts?

I’m not sure why both would be necessary given your Gleason score? Unless it has spread beyond the prostate. The point of HDR is to get the cancer damaging as little collateral tissue as possible. Why then apply external beam which doesn’t have that characteristics unless it has spread. If it has spread, then the external beam may make sense.

@thmssllvn
I agree it makes sense to do HDR Brachytherapy first, followed later with external beam radiation (2 weeks later with 5 sessions SBRT). That was my treatment plan with Dr. Chang at UCLA.
18 months later, according to my RO there's "no evidence of disease".
(Prior to treatment, PSMA PET scan showed my stage 2 Gleason 9 cancer was confined to the prostate.)

@michaelcharles That has been my experience at Mayo Clinic - kind and genuinely concerned and caring.

cstrutt62 commented " I believe that HDR is generally believed to do a better job than LDR, but you might check that out." It is an intensive doctor facility activity which presumably is far more lucrative than a 20-30 minutes procedure in performing permanent interstitial radiotherapy. The study at Keiser described as well as those mentioned by Bansky and Grimm that permanent seeds are best. thanks to pdcard 4756 for the linked video below. Maybe the $$ incentivized HDR will prove equi-effective without the symptomless but life long burden of dealing with seeds sliding around.

Part 2 If HDR brachytherapy may provides Optimal and safe radiotherapy would it not make sense to use it first and then EBRT as a boost.?

My RO used one HDR high dose brachytherapy procedure as a "boost" to 25 rounds of daily IMRT and 6 months of Orgovyx ADT.

My understanding is that the combination of external beam and some HDR has been proven to be more effective than external beam alone. I am now 3-4 months post treatment with my next PSA in January. First post treatment PSA went from 7.1 to 0.04. So far...so good.

You might consider looking into the combo treatment program of external + HDR. I feel the three pronged treatment plan was the best I could get for my clinical situation. Frankly, I had no real issues with any of it and feel great.

This might be of use to you. https://www.youtube.com/watch

Your numbers are like mine. I filled up with the "premium" radiation (HDR). It takes two visits, but you get the blast needed and you're free of long-term pellets to slide around for life. I believe that HDR is generally believed to do a better job than LDR, but you might check that out.

@octopuss Hi I read your post sounds great for you how are you now! I’m facing all these challenges to start in January 2026 luton in a week
Thank you god bless

@capatov thank you so much I’m trying I’m desperate I am happy for you .
Good blessings on your journey I will stay optimistic I hope I can find a support team as yourself
Thankyou

What I have read is that you are an in the ideal range for low dose permanent seed radiotherapy. The low dose is a misnomer. It should be renamed Optimal dose interstitial radiotherapy (a/k/a permanent seeds. External beam radiation is suboptimal. Any higher external source would be injurious to healthy tissue. The long term results: cures are the highest with 'seeds. Like any artful application of science the more on does the better the results. It is 30 minute outpatient procedure with spinal or general anesthetic.