The Photon vs. Proton question is one of the least well documented at this moment and something that I struggled with considerably. PCF repeatedly states generalizations about how there is no proven benefit to Proton radiation over Photon: "Protons are similar to photons (traditional x-ray radiotherapy) in many ways. However, proton beam therapy has not been shown to improve cure rates or quality-of-life outcomes over other forms of radiation therapy, and may actually increase rectal side effects." I have made several requests for a deeper dive and tried to bring up the topic on webinars, but, got a strong 'read our statement' reply.

I can see a lot of reasons for the lack of clarity including the fact that the research is indeed not done and may not even be planned. Of course, comprehensively defining the efficacy and side effects comparison is beyond layman and Drs. alike.

Additionally:
- Proton machines, that cost upwards of $150M, are not widely available, hence, publishing reports that they produce better results opens up an issue on treatment equity.
- Centers that offer proton radiation are likely biased since they have to recover the cost of investment and that won't happen if their Drs. don't insist that it's better.
- While photon side effects from 'shoot thru' radiation cause side effects, the treatment protocols have been in place for 20+ years and, for the most part, patients fully recover.

I was treated, tried-modally, with ADT/Orgovyx; 2x SBRT boost radiation @ UCSF and 25xEBRT @ Stanford (15/16 cores: 3+4; 1/16 cores: 4+3). There were many reasons for this choice and I considered the full range of available options including those with significant travel. Proximity to the treatment center is certainly an important factor and visits to Stanford are almost fun as the campus is so beautiful and the staff so pleasant. Stanford, where many of today's radiation techniques were pioneered by Dr. Malcolm Bagshaw, et al, stated, categorically, that there was no proven advantage to proton radiation, which they do not offer. It was only in a sidebar conversation with a resident that I learned that the machines were coming in 2025, but, like all building decisions in Stanford/Palo Alto, it's nearly impossible to get approval to build.

Thankfully, my treatments concluded about a month ago and most side effects are gone or are highly reduced.