I came within 18 hours of chemical castration (aka ADT, which they euphemistically like to call "hormone therapy") which is typically done in conjunction with external beam radiation. Neither my urologist nor my radiation oncologist ever suggested that avoiding chemical castration via brachytherapy might be an option. Via lots of research, I cancelled the hormone shot and now am scheduled for HDR brachytherapy. Luckily for me, my caner is small enough and localized enough that this has a good chance of being a successful monotherapy. For those out there who have been told they need external beam radiation with hormone suppression, I urge you to investigate the long term effects of chemical castration..... from what I can tell, you will never be the same. Logically, brachytherapy (either low dose permanent seeds which deliver a higher dose in the long run, or high dose which is a quick but very strong 2-session exposure) makes a lot of sense as it delivers radiation most directly to the location of the cancer. There are also side effects to brachytherapy, of course. These include urinary problems (relatively short term) but these side effects PALE in comparison to chemical castration. PLEASE do your own research and do NOT just accept what the first doc says. A doctor is very likely to recommend the thing that they are specialized in, be it surgery, external beam radiation with chemical castration, or brachytherapy. This is not like being treated for a broken leg where the solution is a no-brainer.... YOU MUST DO YOUR OWN RESEARCH.
It’s interesting and disappointing that in 23 minutes Dr. Crook can explain the granular pro’s and con’s of mono brackytherapy v. Combined EBRT. But few doctors I’ve encountered don’t explain much. They barely give you the rationalization for their direction of treatment. They seam taciturn, uncommunicative, solitary fellows. With the thousand of power point presentations, and the reoccurrence of patient/prostate conditions, you this they could make a presentation with images, and charts, and pro’s and con’s for what “they are recommending”. Where they had 8 years to understand your condition, they give you 20 minutes to understand it and three months to make a decision. And, the so called teams your getting at these institutions, seam like they barely speak to each other. What a state!
What is the litature say about yearly psa tests preventing this dilemma. I mean the possibility of intermediate appearing in 12 months? A 2mm lesion with high Gleason is still only 2mm. No money in seeding. PSA under 10 still often 1 out of 4 being cancer no matter what the radiologist rate the tumor. You as the practitioner do the heavylifting and often can read a prostate MRI better than a radiologist. A experienced urologist will often disagree with the Radiologist ratings. Plus very small lesions and very few tend not to send alarms off until biopsy the true indicator. Hopefully this simple blood test will be done yearly starting at age 45. Catching early is ways important. Hopefully a focal therapy like Lazer upon early encapsulated cancer will be the future. Unfortunately urology surgeons still preach prostectomy as the gold standard.
