HDR brachy vs SBRT

As someone else that is blessed with a devoted and energetic partner, I'd like to echo John's comment above that it makes all the difference in the world when you go through this!

Hi:

As a G9, I have had SBRT twice, once in 2011 to zap my prostate, and mets located in the left acetabulum and right trocanter (femur), and again in 2012 to zap a met in my left ischism. I have had no SEs from these procedures and despite many subsequent scans (including two C-11 PET/CT scans with acetate), there has been no fresh activity in the treated areas.

Instead, my recent met is a right pleural effusion, which is being successfully treated with Taxotere.

Houseboy

I had HDR and IMRT and ADT nearly six years ago. Absolutely no urinary or ED issues. During the radiation treatment I had increased frequency and urgency but that stopped within a couple of weeks after the radiation treatments stopped. After the first HDR I had a few days of urinary burning from the catheter. For the second HDR they used a numbing agent for the catheter and no burning. The only sexual issues were the normal loss of libido while on ADT. Now that the T is back in normal range all is good. All the radiation does significantly reduce the amount of ejaculate, but that is a normal and expected side effect.

I had a recurrence of irritative urinary symptoms (frequency, urgency) one year after treatment. I took Rapaflo, which cleared that right up. It lasted a couple of months. Since then, no symptoms whatever, other than loss of ejaculate.

I did have an unrelated prostate infection last year - I'd notice a single drop of blood at orgasm. This went on for about 2 weeks. My urologist prescribed an antibiotic that cleared it up.

I think about 30% of men have these kinds of grade 1 or 2 late term urinary side effects, usually within a year. Late-term rectal SEs are less common. Late term SEs are typically transient, and recur less frequently over time. Sexual SEs, if they occur, usually show up within 9 months of treatment. Katz did an analysis of late term effects - it's in the link in my signature.

Hmm. My RO recommends cutting out fruit juices, cranberry and citrus (and coffee too), because they stimulate kidney function. Since the irritative symptoms make you want to pee more anyway, he doesn't think adding cranberry is a good idea.

So much good info here already Suz, I really don't have much of anything to add, except to say I also narrowed my treatments down to HDR, SBRT, and PBRT. I ultimately chose HDR and had two fractions a week apart in Feb 2016 (see the link in my sig for the blow by blow experiences). While HDR is obviously more invasive than SBRT or PBRT, the way my doc put it, was that of all the RT treatments available, HDR has you exposed to radiation for the least amount of time overall. Granted, higher dosage for sure, but the only time your flesh is exposed to RT with HDR is literally while the pellets are temporarily inserted via the hollow catheters. With LDR, you've got low radiation pellets irradiating for 6-9 months. With any beam therapy, that beam is coming into contact with healthy tissue no matter how you slice it. Each beam therapy has it's pluses and minuses in how it impacts healthy tissue. I also found the more recent studies and findings for hypo-fractionation RT's (HDR and SBRT) to be persuasive when compared to hyper-fractionated RT's (LDR, PBRT, IMRT, etc.). It's entirely possible it doesn't really matter at all in the final analysis, but it made a difference for me personally in my decision making process, and I think at least to some extent these decisions are very personal in nature, even for those of us who are logically data driven and endorse evidence based medicine. Just my .02!