Sorry to hear about
your Dx. You would be classified into the "favorable intermediate risk" category, which means that any of the treatments that are good for low risk are good for you too. You could probably even get away with some very closely watched Active Surveillance for awhile, although the PNI makes that more problematic. All popular therapies - surgery, SBRT, HDR brachy and LDR brachy - in the hands of the right specialist have odds greater than 90% of being curative. They differ greatly in the expected side effects, and other things that may or may not be important to you.
I hope you've already read the sticky "for the newly diagnosed" and have followed the recommendation therein to have your biopsy slides sent to Bostwick or Epstein for a second opinion.
I hope too that you know that you can and should take your time in making this important and irrevocable decision. In our era of specialists, you will have to seek out and interview specialists in each of the therapies that are good for you. You should also assess what is most important to you other than cancer control:continence? erectile function? having a pathology report and undetectable PSAs? There may be comorbidities that affect your decision too; e.g., CV disease, diabetes, large prostate, urinary strictures, hernia, anatomic abnormalities, etc.
To directly answer your question about
using salvage as the basis of your decision, I agree with the above posters that that is an absolutely horrible
basis for making a decision. You may be interested in my recent post on the subject: Why salvage radiation is bad
For all forms of radiation, salvage focal
radiation with brachy or SBRT is possible, as is ablation. However, local failures only account for about
20% of radiation failures, and because radiation also treats an area outside of the prostate, salvage radiation after radiation is unlikely. Salvage anything
increases side effects. Given that they are equally curative, choose the therapy most suited to you, and deal with the low probability of salvage only if you have to.
I don't know who told you that combination brachy+EBRT is a good therapy for your case, but to me it seems like overkill for favorable intermediate risk, and is likely to leave you with unnecessary side effects. Monotherapy, and certainly without hormone therapy, should be sufficient.
Here are the specialists I would talk to in the Chicago area:
• Surgery: Dr. Catalona at Northwestern
• LDR Brachy: Brian Moran at Chicago Prostate Cancer Center
• HDR Brachy: Alvaro Martinez in Detroit - he's worth the trip.
• SBRT: any of several CyberKnife centers in the Chi area.