Hi Jeff (and Ford!),
I'm a lot younger than you but deliberated long and hard between Brachytherapy and RARP. My gut told me BT was the right choice because it's so much more straightforward and has far fewer side effects but despite that, popular opinion always seems to advocate RARP for 'greater certainty in the long term'. That caused some consternation because when choosing a treatment at the ripe old age of 48 and wanting to still be around at 90, the 'long term' is quite important!!
But in fact, when you take 'opinion' out of the equation and actually look at the stats and the science, there is no greater certainty for success by choosing RARP over BT.
The only certainty is that by choosing RARP, you would be choosing major surgery and a lengthy recovery instead of a procedure that's done as a day case in a couple of hours with minimal recovery. The likelihood of suffering from side effects in urinary and sexual function are also far less with BT than RARP.
Despite that, not everyone has the luxury of choice - some centres don't offer BT at all and some people just simply aren't suitable candidates for it (but on the face of it, your PSA and gleason certainly wouldn't preclude you.)
If you have a very large prostate, you may not be suitable for BT and similarly if you have exisitng urinary issues, BT might exacerbate them further which might put you off it as a treatment.
If you haven't already, you should score yourself on the IPSS questionaire to get an idea as to whether you're likely to be suitable for BT. In general I think the cut off is about 10 but even if you score higher, it's still worth a discussion with a consultant who specialises in BT.
IPSS Scoring
Of course, having chosen BT myself, my bias might seem obvious but equally, having been through the process and having the benefit of time and distance from the decision making process, I would always recommend BT over RARP (if you're a suitable candidate for it) but even more so to anyone 'older' who may find recovery from the procedure more difficult than a younger man - why would you want to put yourself and your body through major surgery unnecessarily if there's a much simpler and just as effective solution available?
You can find links to my own journey in my profile and there's a number of other BT stories on these forums (although only a fraction compared to people's RARP journeys unfortunately).
You might also find some of Dr Scholtz's interviews on YouTube interesting - although he may harbour bias towards radiotherapeutic treatments, he makes some astute observations as to why surgery is probably pushed as a primary treatment when other equally successful options exist.
Why Doctors don't talk about Brachytherapy
Comparing Surgery and Radiation for Prostate Cancer
And for a deeper dive into BT and outcomes, this is quite an informative if lengthy watch!
Prostate Brachytherapy
Finally, as I say to everyone, please make sure you speak to consultants who actually specialise in and carry out Brachytherapy procedures as well as surgeons who perform RARP's. Bias, seems to be the theme of this post but it doesn't take a genius to realise that consultants (in any speciality) who have trained their whole lives to deliver a highly specialised form of treatment aren't particularly likely to then advise you to take advantage of someone else's speciality!
I spoke to 2 different urologists (surgeons) and 2 different oncologists (radiation and BT) before making a decision. I found the extra information you glean from them every time you speak to them is amazing. One of the surgeons and one of the oncologists I spoke to were through the NHS (remember you can ask your GP to refer you to both and also ask for a second opinion/referral if you wish).
Best of luck with the decision making!
Cheers!
Paul
Edited by member 29 Jul 2025 at 19:12
| Reason: Typos