Op or Brachytherapy

Hi.... 

Same concern as you Being guided towards op but not sure I really want it as the brecht or SBRT is less invasive. So dammed confusing. 

Some sites list the side effects as very similar and some don't. I spoke with oncologist and she said bratty was worse than SBRT. 

Still deciding but lost in the vast amount of info. 

Was reassured by talking to pier support for brachy worth a chat.

Hi,

The side effects are similar, with surgery they are generally immediate but can and generally do improve, more so with urinary issues, ED is more hit and miss, depends on whether your nerves are spared.

The side effects with RT/Bracy tend develop over time

I went the RT/Bracy route mainly because I was T3b so most likely would have needed salvage HT too, plus I was told surgery would be none nerve sparing

Side effect wise I'm more affected by the 2 years hormone therapy which finishes in a couple of months. Its been very manageable (not the case for everyone), but I'll be glad to be off it! I will see what the future holds ED wise but so far things are still working, if less enthusiastically due to the HT.

All the best

John

It is not surprising that an Oncologist will favour his/her discipline whilst a Urologist his/hers. One eminent surgeon said he didn't rate RT, whereas the Consultant of another member of this forum said he could achieve anything with RT that could be done with surgery. In your shoes I would go with whatever you find most convenient. Some men are being offered the 5 fraction (session) RT. This intense regime is said to achieve similar results to the 20 fraction one, although I read only yesterday that a trial is being set up to establish why side effects with 5 fractions are greater. (It did not elaborate on this, aspect other than to say 136 men will partisipate in the trial) for men in Ireland. It is the 'Inspire' trial. The INSPIRE trial refers to two major ongoing clinical studies aimed at improving treatments for prostate cancer: one focuses on high-precision radiotherapy for localized cancer, while the other investigates advanced immunotherapy for metastatic cases. 1. INSPIRE Radiotherapy Trial (Ireland/All-Island) Launched in April 2026, this "all-island" collaboration across Ireland aims to reduce the long-term side effects of radiation treatment for men with localised prostate cancer. Queen's University Belfast Queen's University Belfast +3 Objective: To refine Stereotactic Ablative Radiotherapy (SABR), a technique that delivers high doses of radiation in just five sessions. Key Innovation: It uses a "second-generation" SABR approach combined with a protective gel spacer to shield healthy organs (like the bowel and bladder) from radiation, reducing urinary, bowel, and sexual side effects. Participation: The study plans to recruit 136 men across two years from cancer centres in Dublin, Cork, Galway, Limerick, Waterford, Belfast, and Derry. Leadership: Led by Co-Chief Investigator Professor Suneil Jain from Queen’s University Belfast and sponsored by Cancer Trials Ireland. Queen's University Belfast Queen's University Belfast +5 2. INSPIRE Phase II Immunotherapy Trial This trial (NCT04717154) investigates a combination of immunotherapy drugs for men with metastatic castration-resistant prostate cancer (mCRPC) who have specific genetic markers. ScienceDirect.com ScienceDirect.com +1 Treatment: A dual combination of Nivolumab and Ipilimumab, followed by Nivolumab maintenance for up to one year. Targeted Biomarkers: The trial focuses on patients with specific molecular profiles, such as dMMR (mismatch repair deficiency), hTMB (high tumor mutational burden), or mutations in BRCA2 and CDK12. Recent Findings (ESMO 2024): Results showed exceptional efficacy in the dMMR subgroup, with a disease control rate exceeding 6 months in 81% of those patients, compared to more modest responses in other subgroups. Side Effects: Approximately 48% of participants experienced Grade 3 or higher treatment-related adverse events, such as diarrhoea or elevated liver enzymes. National Institutes of Health (.gov) National Institutes of Health (.gov) +3 Comparison of INSPIRE Trials Feature Radiotherapy Trial (All-Island) Immunotherapy Trial (Phase II) Cancer Stage Localised (Early-stage) Metastatic (Advanced) Primary Goal Minimising radiotherapy side effects Testing dual-drug efficacy Treatment SABR + Protective Gel Spacer Nivolumab + Ipilimumab Locations Ireland (Multi-site) Single centre (Radboudumc) Would you like more information on how to enroll or the specific genetic markers required for the immunotherapy study? This is for informational purposes only. For medical advice or a diagnosis, consult a professional. AI responses may include mistakes. Learn more

Not helpful to our member other than to note that the 5 fraction protocal is said to produce greater side effects but this is not well stated here. 

Edited by member 23 Apr 2026 at 16:44  | Reason: Additional info