@jeffmarc As a layman, I don't think this study proves anything other than after 12 years one can still feel the side effects of removal or radiation. With all do respect, it strikes me as misleading. Their data set included both those that had radiation and those that had their prostate removed. There data collection made no comparisons from one radiation machine to another (or for that matter the type of prostate removal that was done) but instead seemed to say, without addressing any form of radiation, the type of machine, the margins used that impact healthy tissue, that one could have more problems than people who were untreated, after a 12 year period.

I believe that with radiation, how much healthy tissue is exposed to radiation matters. Margins matter, and so do possible microcells, which is why the standard of care for many types of radiation includes the entire prostate plus a margin.

Without including the types of radiation machines, radiation methods and types of prostatectomies, the study conveys an incomplete conclusion that one better watch out, even after 12 years, for bad side effects. I was treated with the Mridian narrow margin built in MRI radiation machine and finished in 2023 with minimal symptoms. Potential microcells notwithstanding (which is one reason why we all continue to test), I would be surprised, if I am alive at 82, that I would be feeling new symptoms or exacerbated symptoms at that time. I am not sure but we will see. Certainly our treatment choices can have a short, medium and long term effect but I believe that is not in a trial/study vacuum that disregards technological advances.

One final thought regarding any study that does not include radiation machine type comparisons comes from the Mirage randomized trial study which concluded "In this randomized clinical trial, compared with CT-guidance, MRI-guided SBRT significantly reduced both moderate acute physician-scored toxic effects and decrements in patient-reported quality of life."