Western Radiation Oncology
I was just diagnosed with prostate cancer. What should I do first?
Take a breath. A new prostate cancer diagnosis is serious, but in most cases it is not an emergency. You usually have time to understand your pathology, confirm your risk category, and hear from the right specialists before making a decision.
Start by gathering the basics: your PSA, biopsy report, Gleason Grade Group, MRI or staging results if available, and any prior urology notes. Then get at least one more opinion. In my view, the best early decision is often not choosing a treatment right away – it is making sure you fully understand your options first.
What are the main treatment options for localized prostate cancer?
The main evidence-based options are active surveillance, surgery, external beam radiation therapy, and brachytherapy. For some men with low-risk disease, active surveillance is absolutely appropriate and may help them avoid or delay treatment side effects.
For men who need treatment, the “best” option depends on the details of the cancer and the patient. Age, urinary symptoms, prostate size, MRI findings, baseline sexual function, general health, and personal preferences all matter. A good consultation should help you compare those choices in a balanced way.
What is brachytherapy and why might it be considered?
Brachytherapy is a form of radiation in which we place small radioactive seeds directly into the prostate. In low-dose-rate brachytherapy, the procedure is typically outpatient, performed with ultrasound guidance, and completed in a single treatment day.
It deserves consideration because it can offer excellent long-term cancer control with a short treatment timeline. It is not the right fit for every patient, but for appropriate men – especially those with low-risk, favorable intermediate-risk, or selected higher-risk disease as part of combination therapy – it is one of the most important options to discuss.
Will prostate cancer treatment affect my sex life?
This is an important quality-of-life question, and patients should feel comfortable asking it early. Different treatments can affect erectile function in different ways, and the impact depends in part on age, baseline function, other medical conditions, and the specifics of the treatment plan.
In general, surgery, external beam radiation, and brachytherapy can all affect sexual function, but the rates and timing are different. I encourage men to ask each doctor not only about cure rates, but also about urinary, bowel, and sexual side effects over the short and long term.
How long does treatment take?
The time commitment varies significantly. Brachytherapy is usually a one-time outpatient procedure. SBRT is commonly completed in four or five treatments over one to two weeks. More conventional external beam radiation courses can take several weeks. Surgery is one operation, but recovery may take longer than many men expect.
For patients who are working, caregiving, or trying to minimize disruption to daily life, treatment logistics matter. The right treatment is not just about cancer control – it is also about how that treatment fits into your life.
I have high-risk prostate cancer. Does that change things?
Yes. High-risk disease often requires combination treatment, and that is where subspecialist input becomes especially valuable. Depending on the case, treatment may include external beam radiation, brachytherapy boost, and androgen deprivation therapy (ADT), sometimes alongside surgery discussions as well.
One reason I think brachytherapy should remain part of the conversation is that it may improve disease control in appropriately selected higher-risk patients, and in some settings it can support shorter or more individualized hormone therapy decisions. High-risk disease is exactly where a second opinion can be most useful.
A helpful example is the ASCENDE-RT randomized trial. In that study 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 compared with 62% with a dose-escalated external beam boost, and men in the external beam boost arm were about twice as likely to experience biochemical failure.
The TRIP/TRIGU0907 trial adds another important point for selected higher-risk patients. In that phase 3 study of 332 men treated with brachytherapy plus external beam radiation, the 7-year cumulative incidence of biochemical progression was 9.0% with shorter-course androgen deprivation therapy and 8.0% with longer-course therapy, a difference that was not statistically significant. That is one reason I discuss whether some men truly need prolonged hormone therapy when a brachytherapy boost is part of the plan.
In practice, I have seen this matter a great deal to patients. Men often come in worried that treatment will dominate their next year or two, and many are relieved to learn that a highly focused radiation plan can still be both aggressive against the cancer and realistic for normal life.
What are the common side effects of brachytherapy?
Most men notice temporary urinary symptoms after brachytherapy, such as frequency, urgency, a slower stream, or getting up more at night. These symptoms are usually most noticeable in the early weeks after treatment and then improve over time.
Long-term bowel issues and incontinence are less common than many patients fear, but every treatment has tradeoffs and every patient is different. Part of my job is to help patients understand what side effects are most likely for their specific anatomy, baseline urinary function, and cancer characteristics.
Why do some practices talk less about brachytherapy?
Brachytherapy is a specialized procedure that requires experience, coordination, operating room logistics, and a team that performs it regularly. Not every center has that infrastructure in place, and not every radiation oncologist includes it as a routine part of practice.
That does not mean a doctor who does not offer it is giving bad advice. It does mean that if you want a full understanding of your options, it is reasonable to speak with a physician or team that has direct brachytherapy experience before deciding.
How do I choose the right doctor for prostate cancer treatment?
Ask how often they treat prostate cancer, what treatment types they commonly recommend, and how they decide between surveillance, surgery, brachytherapy, and external beam radiation. Ask how they think about urinary side effects, sexual function, rectal protection, and long-term follow-up.
Experience matters, but so does judgment. The best consultation is one where the doctor can explain not only what they recommend, but also why another reasonable doctor might choose a different approach.
What should I bring to a consultation or second opinion?
To make your first visit more useful, bring as much of the following as you can:
– PSA history and the date of your most recent PSA
– Biopsy pathology report and, if available, slides for review
– MRI, PET, CT, or bone scan reports and images
– A medication list and any history of urinary symptoms or prior TURP
– A written list of questions about cure rates, side effects, and recovery
Where is Western Radiation Oncology located?
We have locations serving patients across the Bay Area, including Mountain View, San Mateo, and Danville, and we work with multiple procedural sites for brachytherapy. For many men, that means they can get a specialized opinion and treatment without traveling far from home.
Next Steps
If you have been diagnosed with prostate cancer, do not feel pressured to make the decision in a single visit. Understand your numbers, hear from the right specialists, and ask direct questions about cancer control, recovery, and quality of life.
At Western Radiation Oncology, second opinions are welcome. We review pathology, imaging, urinary symptoms, and treatment goals with the goal of helping each patient choose a plan that is evidence-based, realistic, and right for him.
About the Author
Dr. Ankit Agarwal is a board-certified radiation oncologist at Western Radiation Oncology who specializes in prostate cancer treatment, including brachytherapy, SBRT, and combination approaches for higher-risk disease. He is committed to helping patients understand their options clearly and make informed decisions with confidence.