Hi,
I am assuming that the 7 4+3 was your Gleason grade. You made no mention of the actual extent of the prostate
involved (this is called the T stage, usually described as to whether 1 or both lobes of the prostate are
involved). You also made no mention of your age, I am assuming that you are expecting at least another 10
years.
The available information makes you intermediate risk for recurrence. For patients like you, external beam is
a valid option with or without the brachytherapy (HDR). Hormones are controversial for intermediate risk
disease (but not for high-risk disease, if your T stage is 3a, you would be high not intermediate risk). I’m
thinking you are more likely intermediate risk, as brachytherapy is not commonly used for high-risk.
Looking at studies concerned largely with intermediate risk disease, the use of external beam radiotherapy
with hormones shows improvement in survival at 5 years (88% vs 78%) compared with radiation alone. Two other
studies showed improvements in terms of PSA remaining low usually called freedom from progression. The
approach remains controversial as the best experience with hormones involves larger studies in high risk
patients.
Using a statistical model (nomogram) with your data , your freedom from progression would be in the order of
60-70%. While this seems modest, bear in mind that a rising PSA does not always translate into reductions in
survival. At 5 years, the chances of having a metastasis would be around 10% only.
You may wish to discuss the estimates with your doctors – as the radiation dose would also play into the
estimates.
The decision to continue the HDR is hard to recommend if you’ve had some complications already and it is
afterall optional (since you still have external beam). Of course, the particular complication which was
infection is avoidable, so there is no compelling reason not to go through with it either.
