Ahoy there seabass, I cannot speak to the differences between proton vs photon radiation as I had 25 sessions of IMRT (or IGRT); had no real side effects at all, just some diarrhea for about a week after treatment, that’s it. No urinary issues at all.
But I did take Orgovyx for 6 months and although there are side effects they vary greatly from person to person. In my case, the hot flashes were tolerable - I mean, you KNOW why suddenly you feel warm so no big deal, right?
Also had fatigue the last 6 weeks or so. But the absolute key is to exercise regularly - with intent! No 2mph on the treadmill, OK? Any form of exercise you choose should be vigorous enough to work up a sweat and weightlifting is a MUST to maintain muscle tone.
You’re not going to the Olympics so use weights you are comfortable with. If you already weight train don’t be discouraged if you have to do less reps or use a lighter weight; that really worked for me.
ADT is a controversial topic but a Gleason 4+3 could be of the “unfavorable” type which makes it more aggressive than Intermediate grade. Also, a Decipher score could really be a game changer in deciding on Orgovyx or not.
I have NO regrets in taking hormones - in fact I changed RO’s because my first one said I didn’t need it and all the historical research said I did. His opinion was based on ONE new study that had many flaws and did not take co morbidities into account. Best
Phil

I do not know which hormone I received but I had a shot that was for 6 months and it was given approximately 3 months before I began my radiation therapy. The side effects from the hormone therapy and the radiation therapy combined was very exhausting for me as I continued to work outside in my lawn service business. Coupled with the summer heat and the work pulse near daily radiation, left me completely exhausted by weeks end. It took me all weekend to recover only to begin it all over again on Monday morning. I started the lawn service after I retired from my regular line of employment. I have now been completely retired for 3+ years. I'm 81 and still on a wait and see for my 3rd time of increasing PSA scores. Four PET scans have produced no visible cancers.