Rising anxiety: my two doctors don't agree

If you try the brachytherapy and it doesn’t work, then you just go back on Eligard. Doesn’t sound like you’re going to lose much by trying it.

Sure, you could get a second opinion, third opinion, At Mayo, But it will be down to is there a different treatment that would keep you off Eligard.

The thing is while Eligard will Keep your cancer under control it eventually stops working and you become castrate resistant. That requires you to get a second drug, an ARSI like Abbie or a lutamide. If the Brachytherapy worked, you might never need to go there.

Just some thoughts>

I'm with the oncologist and @jeffmarc.
But I don't think you should wait for the call. Either chase them at Rochester or (maybe also) contact another prostate oncology office. You may be able to have a video consultation. This waiting is high anxiety.

"High Anxiety" is a delightful Mel Brooks movie (1977). But I digress...

Thanks for the comments. My only hesitation with brachy is that a few people get fistulas, so they have to live with poop and pee tubes hanging out of them for the rest of their lives.

My urologist says if my PSA rises more, he'll add enzalutamide.

Bluegill, although a lifetime of ADT is a lousy thing to ponder, the concerns you raise about fistulas are valid.
You’ve already had radiation (type? SBRT?) so since all radiation is cumulative, the HDR “could” cause the surrounding tissue to become necrotic; I mean, there’s only so much radiation you can get, right?
Does your RO have any plan (gel spacers or similar) to help minimize this?
My suggestion as a fellow forum mate and professional worrier is maybe to stay the course with the ADT while you do more research on the HDR, at least until you know more. Best,
Phil

That sounds reasonable, Phil.

Since I'm handling ADT well, I'd stay on it permanently if I knew it would keep working for another 15 years or so. But, it might be good for just another year or two.

Can Brachy be done if I've had a previous TURP? I have heard different opinions on this.

Understood, two different treatment plans makes sense only because I've lived it. I've discovered my anxiety level rises no matter what. I am 5 years in on this aPC journey. I have two oncologist. One works at the big research medical school and is both a clinician and professor. The other works at my small local hospital. Incredibly they both work well together. Their treatment plans vary because of the medical resources (tools/treatments) they have at their hospitals. Here's what I do when my treatment plans anxiety rising too much. I arrange a consultation with oncologist/professor, she explains things really well, I tend to follow her lead. Hope this helps, I know treatment anxiety can be rough.

The anxiety is real. I remember reading somewhere that significant cancer anxiety and stress occurs in over 90% of all people diagnosed and/or considering treatment options and it's a pretty big deal. If I recall, it was also considered to be one of the highest stress items you'll ever contend with. It makes sense, particularly since most of us equate cancer with certain painful death, which of course isn't true, but you only know what you know.

You can find all the various cancer centers of excellence and talk to any of them about second opinions - Mayo is only one of them, they are peppered all through the world and a lot of them are in the US. They can get your data from your primary urologist/oncologist and work from that. You do not have to wait, nor should you - you must be your own health advocate because nobody else is going to do it for you and if you rely on doctors to tell you what to do then you could go down the wrong path.

I just met with my oncologist. I'm pretty sure I'm going to fire my urologist.

Try to figure this out…

You were initially a Gleason 9, PSA of ??

Any other risk factors: PNI, SVI, EXE, cribriform pattern, biomarker test results, genetic test results, PSMA PET scan results, etc.?

Any adverse side-effects you’re dealing with?

Are you still on ADT? What is your PSA now?

Your doctors provide advice and recommendations. Ultimately, it’s your decision based on what you want and quality of life you expect afterwards.