Low dose brachytherapy long term side effect risk

Thank you so much. Even though we completely realize everyone has own situation and priorities, etc it was very helpful to read through your experiences. The initial choice seems very similar to our current situation and right now, we are leaning towards RP surgery over brachytherapy. Even though long term development of potential rectal and bladder urgency/inflammation issues aren’t common with brachytherapy, my husband really would like to avoid those and prefers to stick with the risks for ED and urine leakage issues related to surgery. Thank you also for your candor about your after effects - it is helpful especially as most information out there is so vague. And also thank you for the link on space oar. We had read a bit about that type of product. As we may need later radiation treatments even if we fully decide for surgery as first line treatment, it is good information to have. I’m very glad to hear your PSA is cooperating with your treatments 🙂 Thanks again

I'll try....but...everyone is different and it's a very personal decision...
diagnosed at gleason 3+4, DRE and MRI showed nothing outside of the prostate, then a full body bone scan was negative for anything there. So working off that information as my doctors basically said, in prostate cancer treatment you have three choices, "watch it" / "kill it" / "remove it". Then they both took "watch it" off the table as the gleason was too high.

Being young(ish, 59 at diagnosis) and otherwise pretty healthy, the surgeon recommended RP. I left that office and went to the radiation oncologist a couple weeks later. He felt, largely for the same reasons, that his option was the best option. That being 40 radiation treatments.

Asking both dr's directly "What would you do if it was you?" They recommended their own disciplines. They were both great guys, very experienced, sit and talk for an hour if you want, I just think they legitimately believed in their own disciplines. What's a guy to do?

I went for the RP for the personal reason that I just wanted the vile tissue removed. I think there was likely a visceral reaction to the "C" word and my brain went to "get it out". My wife felt the same way. Both doctors went down the same list of side effects after treatment with the radiation oncologist adding the " there is a slight chance that the radiation could give you another cancer"

The other factoid that played into it, being a contingency planner type, was what happens when / if it returns. Both doctors agreed that if the RP doesn't get it all, it's much easier to follow up with Salvage Radiation Therapy (SRT) as opposed to working in the other direction. I was told if the radiation treatment doesn't get it all and they have to go to a surgical option later, it's a VERY different VERY specialized surgery. Having said that now, after lurking here for some time, I'm not sure that would be the next step, more likely some sort of chemo unless / until a tumor showed itself somewhere then that would likely be irradiated. (just a guess I really haven't researched that much yet).

Biochemical recurrence came to fruition as after my surgery the surgical pathology report showed that even though the margins were clear (and a lymph node taken and tested for good measure) I had some Perineural and Lymphovascular invasion. The PSA started to sneak up and I went into SRT and hormone therapy (Orgovyx in my case)

I also had a PSMA PET CT scan (with radioactive dye of some sort) that was negative as well, and in retrospect, likely expected to be. I found out from the good folks here that there's only a small change of it finding anything with low PSA, if your PSA is below 0.2, there's only a 30% chance of finding anything even though your psa is on the rise.

Current status, still on the drug for now, PSA last tested at 0.014, no lasting effects from the radiation that I can tell, the only issues from the operation are ED related. I can get semi erect, (not good enough to be of any use to my wife, you just have to be open and get creative) and can get the occasional dry orgasm. Well that was a tad blunt...

Side effects of the ADT are hot flashes, which makes sleeping difficult and "lupron belly" even though I work out and run 8-10 miles a week, and of course, "shrinkage" there are other clinical possibilities, I'll let you look those up. 🙁

One thing I might suggest, if you decide that radiation is the way to go, I might consider some type of protection like Space Oar.
https://www.spaceoar.com/about-spaceoar-hydrogel/how-spaceoar-hydrogel-works/
Best of luck to you!

@havhav, choosing between surgery and brachytherapy is tough. You're right that it comes does to a "choice based on perceived risks", but also which possible side effects will be more tolerable for you and your husband.

@hodagwi @kcinthetropics @bens1 @rso may have some thoughts to share about their experiences with brachytherapy side effects. @jb2buckwater @dougs411 @dandl48 @web265 @vernonkent @waynen @maxvt may also be able to share how they made their treatment choices.

While we wait for others to chime in, I think you'll find this related discussion useful:
- Do you have urinary incontinence after prostatectomy & radiation? https://connect.mayoclinic.org/discussion/urinary-incontinence-1/