Paul: every situation is different regarding radiation and where the cancer is, size of your prostate, metastasis and so on but for me, I had narrowed my choice down to the MRIdian linac machine and Proton Therapy. I chose the MRIdian because of the radiation that healthy tissue around the prostate might be exposed to, which is referred to as the margins. The MRIdian uses 2 mm margins vs 3-5 mm margins for most other types of radiation and machines. Unlike any other radiation machine (except the Elekta which has real time mri as well) it has a real time built in MRI so what you see, is what you treat. I felt more comfortable with that versus fused images transferred over to other radiation machines. I wanted the real time dynamic planning capabilities. The MRIdian also has an auto shutoff feature that turns off if the machine detects radiation going outside the mapped area. The Mirage randomized trial study also confirmed to me the importance of real time imaging benefits.

I also had spaceoar inserted to separate the rectum from the prostate.

There are many success stories with Proton therapy as well as other radiation machines. Others will talk about their success with Proton. For me, if Proton therapy had the MRIdian features, I might have chosen Proton. Its beam goes in and based on a calculation, stops at the end of the treatment spot. I had two radiation oncologists with experience with both the MRIdian and Proton therapy mention the rectum bleeding issues associated with Proton therapy, whether they had spaceoar or not. Others on this site did not have issues with bleeding rectums and proton therapy and swear by Proton Therapy. Most people have been satisfied with their choices and you are asking a bunch of patients with lots of different experiences for feedback so…good for you. All the responses mixed in with some doctor expertise should give you more comfort with your decision.

There are many questions to ask but knowing that all your choices are promulgated as somewhat equally successful in the long term, you might want to ask: if you can get treated in 5 hypo fractional sessions, what margins are being used by any machine the institution uses, do they offer spaceoar or bioprotect spacers, can you get a Flomax prescription for urine flow ahead of your treatment and generally, focus on any question that helps you feel better about short and medium term side effects. Sometimes the side effects with whatever treatment you choose are short term a d sometimes not. Get multiple opinions, Telehealth or otherwise. Clearly it’s not your first rodeo with cancer but one day at a time and keep coming back.