The Peninsula is where many of our prostate cancer patients live, work, and want to receive care close to home. From San Mateo and Burlingame to Redwood City, Menlo Park, Palo Alto, and Los Altos, men often want two things at once: strong outcomes and a treatment process that feels organized and convenient.
That is one reason I like caring for Peninsula patients. A thoughtful consultation here can be very practical – review the biopsy, sort out the risk category, talk honestly about surveillance versus treatment, and map out a plan that fits both the cancer and the patient.
After the diagnosis: what Peninsula patients should know
Once prostate cancer is diagnosed, the most important early step is understanding the details of the disease rather than reacting to the word “cancer” alone. PSA, Gleason Grade Group, MRI findings, number of positive cores, and baseline urinary function all shape the treatment discussion.
This is especially important for intermediate-risk disease, where there can be a meaningful difference between favorable and unfavorable intermediate-risk cancer. Two patients may both be told they are “intermediate risk,” but the treatment recommendation can still be quite different.
For that reason, I encourage Peninsula patients to ask for a precise explanation of why they fall into a given risk group and what options are reasonable for that exact profile.
Why brachytherapy deserves a place in the discussion
Brachytherapy remains one of the most important radiation options for prostate cancer. In low-dose-rate brachytherapy, small radioactive seeds are placed directly into the prostate during an outpatient procedure, allowing highly focused treatment with a short overall timeline.
I think it deserves a place in more consultations because it can offer excellent cancer control, an efficient treatment course, and a favorable quality-of-life profile for the right patient. It is not appropriate for everyone, but it should not be left out of the conversation simply because it is specialized.
The reason I say that is because the outcome data are specific. In ASCENDE-RT, a randomized trial of 398 men with intermediate- and high-risk disease, the 9-year biochemical progression-free survival was 83% with a low-dose-rate brachytherapy boost versus 62% with a dose-escalated external beam boost. Men in the external beam boost arm were about twice as likely to have biochemical failure.
For selected low-risk and intermediate-risk patients, brachytherapy may be used alone. For selected higher-risk patients, it may be used as a boost with external beam radiation and hormone therapy. The key is thoughtful patient selection rather than a reflex recommendation.
Matching the treatment to the patient
One of the advantages of practicing on the Peninsula is that we can make these decisions in a coordinated way. Some men are best served with active surveillance. Some are better candidates for surgery. Some clearly benefit from brachytherapy. Others are better suited for SBRT or a longer external beam course because of anatomy, prior procedures, urinary symptoms, or personal preference.
A good consultation should answer not just “what can be done,” but “what makes the most sense for me?” For many Peninsula patients, that clarity is the most valuable part of the visit.
That patient-specific thinking also matches what I hear in clinic. Some men on the Peninsula care most about avoiding surgery, some care most about minimizing disruption to work, and some care most about preserving urinary control. I have seen patients do very well when the treatment choice is built around those real goals instead of a generic script.
High-risk disease and the TRIP trial
For higher-risk disease, treatment is often more intensive, and that is where evidence about combination therapy matters. One of the practical questions patients ask is how much hormone therapy they may need and for how long.
Data such as the TRIP trial have helped move the discussion toward more individualized treatment intensity in selected patients receiving a brachytherapy boost. That does not eliminate ADT for everyone, but it does support a more nuanced conversation than the older assumption that longer is always better.
In TRIP/TRIGU0907, 332 men treated with brachytherapy plus external beam radiation were randomized to shorter versus longer androgen deprivation therapy. At a median follow-up of 9.2 years, the 7-year cumulative incidence of biochemical progression was 9.0% in the shorter-course group and 8.0% in the longer-course group, without a significant difference. That is one reason I discuss whether selected higher-risk Peninsula patients may be able to avoid years of ADT when brachytherapy is part of a well-designed plan.
SBRT on the Peninsula
Not every Peninsula patient is a brachytherapy candidate, and some prefer a noninvasive external beam approach. SBRT can be a very appealing option because it is completed in just a few treatments and can work well for appropriately selected men.
At El Camino Hospital in Mountain View, we use modern image-guided techniques and, when appropriate, rectal spacing strategies such as SpaceOAR or Barrigel to help reduce radiation exposure to nearby tissue.
A practical Peninsula care path
For many patients, the process starts with consultation in San Mateo or Mountain View. We review records, discuss treatment goals, and decide whether additional imaging, pathology review, or urology input is needed.
Because so many patients are local, follow-up can also feel straightforward. Men from Burlingame, Foster City, Belmont, San Carlos, Redwood City, Menlo Park, Palo Alto, Los Altos, Woodside, and Half Moon Bay often appreciate being able to receive specialized care without turning treatment into a major travel project.
Your care team
Our prostate cancer team includes physicians with deep experience in radiation oncology and brachytherapy. In my own practice, I place a great deal of emphasis on matching the treatment to the biology of the disease and the quality-of-life priorities of the patient.
That means talking through candidacy carefully, not overselling any one option, and helping patients understand both the strengths and limitations of each path.
Take the next step
If you live on the Peninsula and have been diagnosed with prostate cancer, I encourage you to get a consultation that is specific to your risk category, anatomy, and goals. Bring your PSA history, biopsy report, MRI, and your questions about surveillance, surgery, brachytherapy, SBRT, and side effects.
Second opinions are welcome. The right plan should feel evidence-based, individualized, and realistic for the way you actually live.
About the Author
Dr. Ankit Agarwal is a radiation oncologist at Western Radiation Oncology specializing in prostate cancer treatment on the Peninsula and throughout the Bay Area. His practice includes brachytherapy, SBRT, and individualized treatment planning for localized and higher-risk prostate cancer.