Treatments Likely to be Recommended by one of your doctors:
There are four main possible treatments for prostate cancer.
1) Radical Prostatectomy
2) Brachytherapy - Low Dose Rate (LDR)
3) Brachytherapy - High Dose Rate (HDR)
4) Radiation Therapy

1) Radical Prostatectomy
Quite simply this means a total surgical removal of your prostate gland. The prostate produces semen and also helps control bladder flow, so removing it can mean difficulty controlling your urine (incontinence) and will also mean that if you are able to have sex afterwards (you certainly might be able to) that you won't feel quite the same sensation. Often men are able to achieve erections and have satisfying sex after their prostate has been removed, but in some cases they are left impotent - that is they can't get an erection. This will generally be due to nerve damage that the surgery imparted to the genital area, not to the gland removal. (A good friend of mine named Jim M. had this type of treatment.)

2) Brachytherapy - Low Dose Rate (LDR)
This is a relatively new but effective type of treatment that involves physically placing small radioactive seeds directly into your prostate. (They are eventually ex pulsed via urination.) This form of therapy is generally used for cancer with mid to low Gleason scores for cancer that is only in the prostate (ie it hasn t spread.) The main advantage of this type of treatment is that it can very accurately target the effected area of the prostate and avoid side-effects that standard radiation therapy can produce in adjacent organs / tissue such as discomfort and difficulty with bowel movements, incontinence and possibly also impotence. A downside of this is that the procedure to implant the seeds is invasive and can be painful for a period of time after it is performed.(A good friend of mine named Victor D. had this type of treatment.)

3) Brachytherapy - High Dose Rate (HDR)
This is a very different type of therapy than the LDR variant also effective in that it is targeted directly to the prostate, and it is similar in that it produced radiation that is directed into the prostate but in this case via a number of (temporarily) implanted wires such that the risk of the side effects of standard radiation is also minimal. The advantage of this form of therapy is that it only takes 2-3 applications, generally up to a week apart, so it is completed fairly quickly. But the downside is that similar to LDR the procedure is again very invasive and the aftermath is painful, and a catheter is generally required to urinate for a day after the treatment. (A good friend of mine named Don L. had this type of treatment.)

4) Radiation Therapy
Radiation Therapy is a whole school of treatment - there are a number of different types of radiation therapy. Some of these include (and this is by no means an exhaustive list) the most common type known as External Beam Radio/Radiation Therapy (EBRT), intensity modulated radiation therapy (IMRT) (which is a subset of EBRT), tomotherapy or helical tomotherapy (HT), image-guided radiation therapy (IGRT) Cyber knife, and a newer (and rather less common) version of EBRT known as Proton Beam which is currently only available in a few locations in the U.S. (Beaumont in Michigan has it.) This type of treatment can be done in a few high intensity applications, but for the prostate organ, it is usually done with a fairly large number (up to 44) of relatively low dose treatments (to help avoid side effects to nearby organs such as the rectum and urethra).

I had radiation treatment (in the form of EBRT) and I had the maximum number of treatments, that being 44, so 9 weeks of treatment administered 5 days per week. (It may actually have been IMRT, I'm not sure. According to CencerCenter.com, IMRT is the most common form of EBRT used to treat prostate cancer.) Other than the duration and daily time commitment, the biggest issue for me was the preparation required, specifically this entailed having a full bladder and an empty lower bowel before treatment can begin every day. (Achieving that was a lot of trouble for me - a LOT. See a separate (fairly detailed and humorous) essay on what this involved and how it affected me.)

Who to listen to!
This can be a tough one. If you are a recently diagnosed caner patient, you are likely somewhat (and understandably) frightened and you may not have wrapped your head around things just yet. It took me a while, that's for sure.) And if you are seeing doctors - your primary physician, and probably a urologist, and possibly an oncologist, you may get different opinions on how best to treat you. In the long run you have to make your own decision about what you think it best for you based on your age, the stage level of your cancer. And depending on your cancer's stage (1-4, and possibly also stage 4 metastatic, meaning it has spread already, which sure ain't good and was the case with me), you will have different treatment choices.

Hal Wolfe
April 15, 2019