Hi Ade,
My Dad was about your age when he was diagnosed - treated with LDR BT and SBRT in combination. The SBRT was only because there was a risk of it having breached the capsule. He didn't experience bounce, just a straight line down to undetectable which he's still at today, over 20 years later!
I didn't consider HDR BT - it wasn't even proposed as an option by anyone I spoke to (and I spoke to more than most). I believe the most appropriate (non RP) treatment for you and I with our staging will always be LDR BT.
I know SBRT/EBRT has come on a lot in recent years but in my non medical opinion, it cannot possibly deliver as accurate a dose of radiation to such a small area as LDR BT. When they plan the LDR BT procedure, they use really cool software to work out the dose/number of seeds and where exactly to insert them in the prostate. They up the dose where they know the cancer definitely is and then saturate the rest of the prostate. The aim is to deliver an ultra focused high dose of radiation to just the prostate (and a couple of mm outside it). That way, the risk of radiation damage to anything else is minimal, but comprehensively delivered to the prostate.
Like I say, for me that's absolutely the most accurate way to deliver the radiation. The oncologist who performed my procedure does SBRT but for cancer contained within the prostate, he said he would always advise LDR BT for this reason.
I had mine done privately at Guys. It was actually a two man team who perfomed the procedure - my Urologist who is an absolute BT (and RARP) legend(!) and the oncologist who for want of a better way of describing it has seemingly learnt his trade from the urologist over the years. When I had my procedure done, they had done more than 2000 BT procedures over 20 years and in that time, had seen failure in only 20 cases - that's a failure rate of just 1% !! I also spoke to another very experienced BT specialist at the Christie in Manchester - I got exactly the same reasoning, explanation and similar (marginally worse) failure rates. I decided to go with the guys in London as I'd been under my Urologist's care there for several years since my first 'high' PSA reading (but negative biopsy originally)
I believe the seeds are always stranded. One of mine migrated to a seminal vesicle - I would never have known, it didn't and doesn't cause any problems, was told it wouldn't go anywhere else and that it was rare for them to migrate. The oncologist actually wryly commented when he saw it that 'and they claim we can't treat seminal vesicles with BT' 🤣
Yes, I discussed salvage options at length with both the urologist and oncologist. My primary advice to you however would be to absolutely not focus on the potential for failure (and the requirement therefore for salvage) as it's extremely unlikely given your staging that your treatment would fail. However, I understand it's natural and like you probably, initially the prospect of wanting to keep all options open caused me some consternation.
The urologist said that salvage RP is something that is absolutely possible after BT. More difficult yes but 100% possible - he has done salvage RP in some of the few cases where BT failed. I doubt the chances of normal sexual function afterwards would be great but normal urinary function stands a much better chance.
The oncologists comments re salvage had some of the greatest effect on me at focusing my mind as to what was the right primary treatment rather than what might be best from a salvage perspective. He said that whilst salvage RP might not be great, neither is salvage radiation treatment after failed RP. He said he does a lot of salvage RT after RP (remember about 30% of people who have RP will require salvage RT) and delivering salvage RT is difficult and often leads to more problems (urinary/sexual function) because it's not as focused and the prostate isn't there to protect other critical organs/body parts from the RT. So damage to the bladder/rectum etc is more likely.
Finally re salvage, when my PSA started to increase after the procedure, after a year of increases, I was just about to have another biopsy (consultant anxiety!!) and the consultants were talking about being able to do further LDR BT if necessary and the biopsy picked up where any residual cancer was. I'm not sure I remembered that being discussed as a salvage option pre-treatment but it turns out that it can be an effective option 2nd time round in the event of failure. Days before I was due to have the biopsy though, my PSA started to fall and we aborted it and continued to watch it fall over the next 12 months - my next PSA test is in a couple of months and I hope it's continued that trend! Certainly the oncologist signed me off back to the urologist's care for future monitoring, convinced I had/am experiencing nothing more than bounce.
No, I don't and have never felt the seeds inside me - there's absolutely no difference in sensation 'down there'. The procedure is so straightforward it's ridiculous really - I was in and out of hospital in a couple of hours. I stayed in London the rest of that 1st day but then travelled back up North on a train the next day and walked round a golf course with my son who was playing in a competition that day - no problems, no side effects. The urinary urgency did increase a bit over time as the radiation built up in the prostate but nothing serious, just occasionally a bit annoying to be going back and forth to the loo more than usual. That probably peaked at 3-4 months I guess (hard to remember now) but I would say by 10ish months, everything was back to completely normal. Sexual function was normal from day 1 (if you ignore the fact that you only have dry orgasms afterwards!). I was and still am prescribed Tadalafil which I take intermittently, not because I really need it but because actually, it makes me feel like a teenager again 😉🤣. Orgasms initially have a slightly different sensation (I presume because of the radiation damage and the fact there's no 'product'!) but over time, the sensation returns 100% to normal again.
Finally, as above, no HDR brachy was not proposed and I don't believe it would be appropriate or offered in your situation.
Cheers!
Paul
Edited by member 10 Feb 2026 at 09:11
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