I fully agree with Jim's excellent reply and only want to add a couple of comments:
3. I agree that LDR brachy results are all over the map. Good seed placement is almost an art. Imagine trying to stick a staple into a mass of jello and getting it to stay exactly where you want it. It is as important to find an experienced seed doctor as it is an experienced surgeon. Some like Peter Grimm in Seattle get uniformly excellent results.
Incidentally, there is another kind of brachy, called HDR brachy, that doesn't seem to be quite as tricky because the prostate is immobilized and the "seeds" are placed and withdrawn under continuous image guidance. It is very high tech, but gives great results both in cancer control and low side effects and potency preservation. The downside is that it may be hard to find where you live.
4. This is a highly controversial topic. In a recent issue of the journal Brachytherapy
there are two opinion pieces on this issue by two of the brachy "masters," Zelefsky/Spratt
at Memorial Sloan Kettering argue for including external beam radiation for intermediate risk patients, while Stone
argues against adding it. Zelefsky rebuts this here.
. I think they would agree, however, that for your favorable intermediate risk PC (as far as I can tell from your post), additional external beam radiation would be unnecessary as long as the brachy dose were high enough.
HDR brachy monotherapy (without external beam) gives 95+% control rates for favorable intermediate risk men.High Dose Brachytherapy as Monotherapy for Intermediate Risk Prostate Cancer
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 6 year results
treated 10/2010 at age 57 at UCLA
•PSA since treatment:
1/11:3.9 5/11:3.0 8/11:3.7 5/12:1.2 9/12:1.3 5/13:0.4
• SEs of treatment:
after 2 wks: mild urinary & rectal - last 1 wk
1 yr after: mild urinary - last 2 months