Brachytherapy boost HDR vs LDR +/- ADT

[Infamous9597]

A bit of my background: 50 years old, Gleason score of 4+3, a PSA of 11, decipher is low, and possible extracapsular extension.

1) I know what LDR and HDR do, but what are the differences in terms of their long-term side effects?

2) Should I include ADT for a better outcome and what percentage improvement I might see. The radiologist mentioned that ADT is optional in my case.

3) Should I do SBRT, fewer sessions with higher doses, or IMRT, more sessions with lower doses?

[Tall_Allen]

1) A recent randomized trial of the brachy BOOST therapies found that the difference in toxicity has everything to do with the expertise of the RO:

redjournal.org/article/S036...

2) ADT benefits unfavorable intermediate risk patients, at least with EBRT:

prostatecancer.news/2020/09...

3) You may be able to do SBRT monotherapy:

prostatecancer.news/2018/10...

[timotur in reply to Tall_Allen]

Anecdotally, I’ve read if more issues with LDR-BT with the seeds than HDR-BT. I had HDR five years ago with nil side effects thus far. Would suggest a visit with a seasoned RO to discuss options.

[Tall_Allen in reply to timotur]

We no longer have to rely on anecdotal reports since the above randomized trial that shows about equal QOL.

[Jancapper in reply to Tall_Allen]

Yes, this is exactly the type of information I was seeking prior to receiving my PRT in the form of HDBT + EBRT + ADT. Good article for those yet to decide.