How do you talk to patients with intermediate-risk prostate cancer deciding between LDR brachytherapy (monotherapy) vs HDR mono vs SBRT vs EBRT, in terms of the comparative side effect profile of each approach?

It’s hard to add much to Dr. @Dr. First Last's excellent evidence-based answer, but I’ll elaborate on the counseling aspect from my perspective.

Introduction: I start by acknowledging how difficult it is to weigh several totally foreign options and acknowledge the gravity of the decision. My patient...

This is a good question and one with imperfect data. In general, they are all really well tolerated with a high chance of cure and low risk of serious (i.e., Gr 3+) side effects and slightly higher risk of lower-grade GI, GU, and sexual toxicity.

Due to the fact that brachy is provider-dependent with...

I strongly believe in shared decision-making, where I work with the individual patient to select the treatment that aligns with both the currently available medical evidence and the patient's personal preferences. For intermediate-risk prostate cancer, SBRT, IMRT (intensity-modulated radiation thera...