I took the brachytherapy boost option. It gets a higher effective dose into the prostate where the known cancer is, but tends to have a relatively low side effect profile considering the dose delivered. With a Gleason 9, I think that's your best chance of wiping that out. I presume the brachytherapy boost option also includes hormone therapy (mine did, 18-36 months depending on PSA levels at the 18 month point).
An option I was given was to extend the external beam to cover most of the pelvic lymph nodes too, where the cancer was likely to go next, and where there could already be micro-mets (too small to show on any scans). I took this option to reduce the chances of any such micro-mets causing recurrence. This is done at a lower dose than would be the case for known lymph node mets, so it doesn't usually cause any additional side effects. You should ask if that's an option for you, or maybe they are planning to do it anyway.
5½ years later, I'm very pleased with my choice. Loads of detail on my profile too.
I did have private medical insurance and I asked if there was anything available that way which was better, and my oncologist said no - treatment exactly the same, just he got paid more, and I got a private room (which I don't like - I prefer talking with the other patients), so all my treatment was on the NHS.
However, now there would be the option of having Abiraterone added to the hormone therapy for the first 2 years which improves the survival rate, which is the treatment NHS England just refused to fund/make standard, but which is standard in many other countries (including Scotland and Wales) for patients with high risk disease on a curative treatment path. I do know patients who are paying for this themselves while having the treatment and regular hormone therapy on the NHS - it works out around £1000/month when you include all the necessary private blood tests and reviews which go with it, at least initially - that might drop later if less frequent reviewing is required once you've been shown to be stable on the Abiraterone. This wasn't yet known to be a benefit 5½ years ago when I had my treatment, and so not something I considered.
Edited by member 16 Mar 2025 at 02:37
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