Redwing - I don't know if you saw my post from last Friday, but I want to do triple play but I've got a caution flag being raised / suggested based on urine retention (not flow). If you don't mind, what were the urinary issues or risks that were present when you opted to skip the brachy boost?
First again a disclaimer - there are those here who will call upon Zeus to unleash lighting upon anyone even discussing this. So I'm only
relating what I heard, when I heard it, for what it's worth, which is probably nothing. So, ok, having said that yet again...
In 2013, the clinical concern my RO expressed regarding added brachy was specifically about
the risk of urinary strictures. That's the urethra closing down making urination difficult. It wasn't a factor in my case, but some guys already have urine flow issues, and radiation (of any kind) won't help that. I have no idea how that relates to urinary retention.
My own dad had a lot of BPH and resulting urinary issues; at age 72 he opted for surgery in large part due to the risk of radiation making those troubles even worse.
My RO said, almost verbatim, "We have brachytherapy here. If I thought it was better for you, we would do it.". Their clinical experience was that the 79.2 Gy they could safely administer by IGRT on the Varian Trilogy with RapidArc, combined with ADT, would provide effective control. Brachy would add side effect risks without sufficient promise of increased control to make it worth the risk.
That's five years ago now, and there have been a number of studies released in the meantime. Talk to your RO about
it. They learn constantly about
treatments and results, and there are many who have the "triple play" and do great with it.
Your RO is who you should trust, not me, nor any other random guys on this forum even if they come across as authoritative. This forum is good for giving you some questions to discuss with your docs, some angles you may not have considered. But no one here is a doctor.