Whether to have HDR brachytherapy

Hi Bill,

Welcome to the site and sorry you find you're self here. I was diagnosed March(ish) 2024. Initially recommended  surgery, then a second surgeon said HT/RT was the way to go. He could do the surgery, but it would be none nerve sparing and I'd most likely need salvage RT. The none nerve sparing really put me off, and why have a double wammy of side effects too!

I was due to have 20 sessions of EBRT + 24 months of HT. A few days before I was due to start I was called in and offered 15 sessions plus HDR Brachy, the HT was staying the same. I was warned ED and strictures were more likely, which develop over time especially with EBRT and Brachy combined. I went ahead as anything to reduce the chance of reoccurance. ED still bothered me but I thought I could handle it more if it progressed slowly (fingers crossed not at all!)

I've just finished HT and waiting for testosterone to return

The Brachy was very straightforward too, mine was done under general anesthetic. I walked into the hospital at 7am, and walked out again at 12:45 after proving I could wee ok. This is personal experience so I guess its not always so straight forward

I'm only a short way through the journey, but I'd still add HDR Brachy in, especially if it reduced the time on HT. I never had any hint of incontinence and the ED I'm experiencing is down to the HT from what I can tell. A pump and tadalafil from the NHS is helping mini me through the dark times.

Of all the treatments side effect I've found HT the worst, though hopefully these will wear off over the coming months. I'm on tamsulosin for a possible slight stricture (this is what I assume is the problem, I will query at my next telephone appointment if that's the case). It's only very mild and hasn't got any worse, I've tried stopping the tamsulosin, I was still able to pee but with reduced flow and it felt a bit uncomfortable.

All the best

John

Hello Bill,

No problem! You might already know this, but if you click on users names you can view peoples profiles, most people put details of their diagnosis and treatment/experience there which can be helpful to read through.

Hope all goes well with your choice of treatment, it can be rather agonising!

John

I had the HDR Boost treatment (HDR brachy + reduced EBRT + hormone therapy) 7 years ago.

So far, everything's been fine. I have had some minor rectal bleeding, but that had no impact on QoL - just a red line on the toilet paper occasionally. It has almost stopped now anyway. A couple of years after the treatment, I was lucky enough to be able to say to my consultant that I almost wouldn't know anything had been done, which wasn't what I was anticipating at the outset. I can't promise that of course, and some luck is involved. Stricture is a risk for every prostate cancer treatment.

In terms of side effects, my oncologist said he thought the HDR Boost was lower than regular external beam, because the side effects are mostly caused by hitting tissues you didn't intend to (known as Organs At Risk, OAR). Brachytherapy Boost gets a higher effective dose into the prostate (and seminal vesicles in your case) than can be delivered externally without excessive side effects, but still includes the EBRT advantage of spilling outside the prostate at a lower dose to mop up micro-mets (mets too small to show on any scans).

It sounds like you've already looked up that Brachytherapy boost probably has the longest progression free survival time for suitable high risk contained cases. (There are some comparisons here: Compare Prostate Cancer Treatments – High Risk although that only covers LDR Boost and not HDR Boost).