Brachytherapy? Anyone have thoughts?

@capatov hi Í saw your post and am facing brachy +lupron and VMAT. I am assuming you didn’t have prostectomy ? I was told I would need a urologist that could do the surgery cause my robotic urologist won’t due to proximity to rectum. There is one that can. Have not seen him was just informed today of him. But in discussion with intake specialist that would be my choice. I would rather not but I’m still trying to figure out how successful is the alternative no surgery, I read a lot that new studies show not much difference? I’m up and down the scale on Gleason from 6 to 8 last PSA 9.8. Started on bica 50mg a day lupron starts next week and im still at a loss .
Thanks for any input

@clandeboye1 that is what scares me I’m at a loss totally mine is a moderate high risk thou

@islander2025 - I will keep you in my thoughts and prayers.

I am not an MD but my best advice is find your way to an academic center of excellence (major multidisciplinary university medical center) that deals with a lot of PC.

I was lucky my son works as an anesthesiologist at such a place and found me the best surgical urologist and radiation oncologist both willing to treat me.

Wishing you only the best!

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.

@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

@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

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.

This might be of use to you. https://www.youtube.com/watch?v=ZPCQQz06bOc

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.

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.?