How would you treat high risk prostate cancer in a patient with autonomic bladder dysfunction?

Personally, I have not treated a large number of such patients, but they've generally had this problem due to diabetes or Parkinson's disease. However, it might be prudent to wait for the workup for an etiology before starting radiation therapy. For high risk patients, you're generally considering a combination of ADT plus external beam with or without brachytherapy. In patients like this, in whom you're worried about making their bladder function significantly worse in the long term with RT, I have generally used ADT plus external beam alone, conventionally fractionated. I would not consider using LDR brachytherapy as a boost because of increased risk of both short term and long term urinary problems. You could consider an HDR boost after ...