HDR vs. LDR Brachy

This won't particularly help you, but in my case it was simply due to location: I wanted to have my IMRT and brachy at the same facility and UCLA only offers HDR brachy. The more I learned about it, the more it confirmed that I was making the right choice, although that might have been the confirmation bias talking.

Hopefully, Yooper will weigh in as he did considerable research into both types before choosing LDR.

I had chosen the LDR at the same facility and Doctor as where A Yooper had his LDR administered. My choice was based on the expected outcome of this particular treatment especially with this particular Doc administering the seed planting process. Another huge reason was due to the very possible undesirable side effects with other treatments which I certainly did not want to be saddled with especially at my age. My five year mark is going to come up in a couple months. Only YOU can make the decision on which treatment/location to go with. Good luck to ya!!

Thanks for weighing in and helping out our buddy Works Out there BenSam - WO be assured that BenSam did his due diligence and it's great to see him sharing this!

I looked at both. I think that both are excellent, but there are differences. Here's a review that discusses all the technical and outcome differences:

Low-dose-rate or high-dose-rate brachytherapy in treatment of prostate cancer – between options

It is unfortunately very rare that randomized comparative trials are made, but there was one done at William Beaumont Hospital comparing LDR to HDR brachy. They found that the rates of late term/chronic urinary and rectal toxicity were similar, but that "The impotence rate was decreased by half with HDR." Of those who were fully potent before therapy, 82% remained fully potent after HDR, but only 41% remained fully potent after LDR. Rates of acute urinary and rectal toxicity were lower with HDR. Dr . Demanes's 8-year HDR results were similar to the William Beaumont Hospital results.

Arguably, the results are better from Peter Grimm and the Seattle doctors than for the brachy docs at William Beaumont. In fact, in reviewing the Seattle early results vs their current results, I was struck by how much better they are doing now. There seems to be a sharp learning curve with seeds and wide disparities in the results from one place to another. So, comparing the best to the best (Katz for SBRT,Seattle for LDR & Demanes for HDR) monadically (not strictly kosher)...

Maintenance of sexual potency: SBRT (6 yrs) - 75% HDR (8 yrs) - 82% LDR (7 yrs) - 76% (among the most potent, 56% overall)

Acute Grade 2 or higher urinary toxicity: SBRT - 4% HDR - 13% LDR-43% urinary retention

Biochemical recurrence-free survival (bRFS) for low risk patients: SBRT (6 yr) - 97% HDR (8 yr) - 99% LDR (12-yr) - 97%

The reason that SBRT and HDR are able to achieve such great results with low net radiation doses is that they take advantage of the low alpha-beta ratio of prostate cancer - it's killed more efficiently by higher dose rates. LDR accomplishes the same thing with brute force- the total dose is delivered continuously and is 3-4x higher. That's also why the urinary retention rate is so much higher. But that is typically a transient and manageable SE. Late term effects are similar for all of those treatments and are very low.

I think LDR gives great results in Seattle, MSK and a few other places, and not so good results elsewhere. LDR is quicker than HDR, and considerably less costly and less bother.

I considered going to Al Taira in Mountain View for LDR, but UCLA, which offers HDR and SBRT is 10 minutes from home. I chose SBRT over HDR because I preferred no hospital stays. Radiobiologically they are identical (SBRT was designed to mimic HDR), and their oncological and toxicity outcomes are identical as well.