Choice: 28 full-intensity or 39 lower-intensity radiation sessions?

Check with Mayo Clinic Rochester. I was offered 5 Proton treatments. 1 treatment every other day, each treatment lasting less than 5 minutes each. (Mon, Wed, Fri. Tue, Thu, and done!) Virtually no noticeable side effects.

My proton treatment was at Loma Linda in 2010. 2.5 months weekdays of radiation..small doses over a long period in time. For many, the time and cost prevent this option. It appears now the science has improved for shorter treatments. I was Gleason 3 plus 3, T1, PSA 6.47
with localized cancer. Never ever had a problem post radiation. For those men who have this option, highly recommend this treatment.

RH/Florida

I'll tackle one aspect of your 'some of the things I should be aware of'...

I wasn't given an option of 39, I got 28 (with minimal side effects and a successful outcome).

I'm sure some people can manage this better than me but it was a surprising struggle to get to the hospital, on time, with the requisite full bladder (and empty bowels), every weekday for five weeks. I did it and I didn't miss a day's work but it wasn't easy.

Due to ADT or whatever, I began to have 'terrors' inside the machine. I'm not claustrophobic but I became convinced that I was going to move during treatment. It made each session quite... no... very difficult and it made getting the hydration right essential (not waiting 10-15 minutes more inside the machine).

By the end of my program I was a mess and I would not have wanted 11 more sessions.

I had SpaceOAR and five sessions of SBRT radiation. No rectal issues at all. No blood in urine or anything like that. Had tiredness for a couple months, burning and slow urination (Flowmax fixed it) for about 2-3 months. I'm now seven months past radiation and no remaining side effects, though I realize there could be some in the future.

@jcbagley
The addition of being on a blood thinner is a compounded factor. I was on aspirin but was taken off it 2 weeks prior to space/oar and radiation treatments. I then stayed off it for several weeks after. This was per my R/O at UFHPTI. They also took me off on certain supplents and vitamins I was taking.

I will pass on what was told to me by UFHPTI R/O. Even with space/oar (which helps more colon away from prostate) you will probably still get radiation damage to colon as most R/Os will treat what the call margins which is beyond the prostate.

There are tiny blood vessels in the colon. They are easily damaged by radiation. The body will start to replace them but the new tiny vessels are very fragile and easily damaged by constipation etc. Thus it is common to get some bleeding from these new vessels from damage but over time they will get stronger.

You are on a blood thinner. So any bleeding would be compounded by that.

I had minor bleeding (not much more than a spot on tissue) that came several months after treatment ended. It slowly got better and better. Some don't get any bleeding at all and some a lot worse.

From the options given you. You will see posters mention the high dose is usally only a 5 dose over two weeks. I have not heard of some many days of treatment with high dose you were given.

The low dose can be a different number of days but usually is around 30-40 from what I was told and what I have read on MCC. My PCP stated to me (he does a lot of research) that statisics are showing an increase in side affects with the high dose. I guess very long research will reveal informative statistics for patient information.
Good luck!

If you have the option for MRI guided SBRT review rectal toxicity it seems to me it is extremely low. I think I saw 1 or 2%. Other forms of radiation seem to be around 10% grade 2. Just my recollection so please research.

@neilmartin
I am not sure you are referring to past posts about seeing infection rates of 1-2 %. I and others with this % were talking about biopsies not radiation treatments. I don't have any information on infections on radiations treatments. I was never given any information on the type of radiation infections.

There is a difference in infection rates for biopsies between having in done transrectal or transperineally. My Mayo uorologist stated their research was it was 1-2 % increase in infection if done transrectal. Others have posted they were told 1%

I just did not want to take the chance of any increase in infection or the discomfort of having it done transrectal versus being asleep. I may have mistakenly what you were referring to so just wanted to clarify from mine it was referecne biopsies. Do you have information on infections from just the radiation treatments?