First of all, there is no guarentee in this.  I've seen reports from
seed/Rad patients who have had a hard time.

My impression from the message traffic and stats in both pro-surgery
and pro-seed books is that all things considered seeds and rad is a
much easier way to go compared to surgery.  

That was my personal experience but that's only one sample.

As for the medical facility, I went to Inova, In Northern Virginia.
They have a radiation oncology department that is top notch.
However, there are many, many hospitals that have excellent
reputations for success with Rad so you have a choice of
several dozen.

Whatever you friend choses, I wish him well.

May I put in a vote for Morristown (NJ)  Memorial Hospital?  Their
equipment is about as state of the art as you can get and the doctors
are top notch.  I have 4 radiation treatments to go (total of 25) and
will undergo HDR brachytherapy at the end of the month.

I did a lot of research and got many "2nd opinions" before making my
choice.

-Gordy

I am far from an expert so please take my opinion with
many grains of salt.

Gleason 7 is considered to be "intermediate" risk.  Seeding
by itself as a "monotherapy" is thought to be most appropriate
for "low" risk patients, i.e., Gleason below 7, PSA below 10.

The radiation oncologists I spoke to recommended a combination
of seeding plus external beam radiation, possibly combined with
hormone therapy - that's the combination I opted for.

The theory is that with Gleason 7, there is more chance of
extra prostatic extensions of the tumor, and external beam
radiation can treat those because it also treats the
area immediately around the prostate bed.

My personal experience with a combination of high dose
rate brachytherapy (temporary, very "hot" seeds) plus EBRT
plus hormone therapy was positive.  The biggest side effects
were from the hormones.  I had some difficulty urinating
after treatment, some hemmorhoids, some skin burn, but
no incontinence and only a small effect on sexual potency.
However your friend's mileage may vary.

I missed very few days of work, and had little risk of the
surgical complications that can come from prostatectomy.

Seeds by themselves are probably the easiest treatment to
take.  You are generally in the hospital for one day only.  The
side effects are low.  But a more complicated therapy may
be desirable for your friend.  He should discuss these
issues with a radiation oncologist, and probably also
see a surgeon to learn about his surgical options.

I was treated in a clinical trial at the U.S. National
Cancer Institute - which may not be an option for your
friend.

Good luck.

   Alan

Unless your friend is in poor physical shape, the recovery from prostate
surgery is probably not a good criterion for deciding between surgery and
radiation.

However, I believe that quicker recovery is a fact.

The Massey Cancer Center in Richmond, Virginia will only seed with a Gleason
6 or less. That seems to be the norm but there is some new thinking that
allows men with Gleason 7 to have seeds (brachytherapy). It is usually done
with some external beam (EBRT) and possibly some hormone blocker (HT) for a
few months to a year or so.

The external beam is minor. Jump on the table for a few minutes while you
listen to the clicking of the machine around you. Hop down and go live your
life. The seeds are going to make you a couch potato for about 3 days. You
might feel fine but you need to stay quiet so that you do not accidentally
dislodge a seed. The EBRT should be done on an IMRT machine to protect other
organs in the area.

The normal side effects (SE) of such treatment is usually tiredness. I'm
talking about taking a nap or going to bed a little earlier. The only thing
I've ever heard in the way of SE that would prevent someone from considering
seeding is if they are horse jockeys or competitive bikers, something about
slamming that part of you body over the long haul with seeds in there, so
they have to give it up for about a year if they decide to have
brachytherapy.

The other normal side effect is difficulty urinating after seeding. The
prostate tends to swell and it make urinating very difficult. There are meds
for it and they do help. Aside from that there is very little trouble.

Most seedings are done as an out patient and the patient does not have a
catheter when leaving the hospital. Often the hardest part is staying quiet
for a few days after the seeds are placed.

There is no perfect treatment and they all have their drawbacks and SE's.

If you have any specific questions you are welcome to email me.
Bev