@clandeboye1, first thanks for following up! I'll remind you I'm a Gleason 3/4 with < 10% on one core diagnosed as 4. I had 6 cores of 3/3 out of 13 in an mpMRI-guided biopsy. My decipher score was low (.18).

This is a long-winded response to my treatment decision inquiries. Monotherapy RT is my plan. My read of the literature at this juncture is that Proton therapy hasn't realized its potential of reduced toxicity because there isn't the technology to gate the beam delivery to account for intra-fractional prostate movement. Intra-fractional movement of the prostate exceeds 3 mm in approximately 70% of the fractionated sessions, according to one study. That, in my opinion, partially accounts for the increased toxicity of OARs in both proton and photon EBRT. MRIs don't play well with proton beams and tend to distort the beams. As far as I can tell, ultra-fast CTs are just beginning to be paired with Proton, are very expensive, and seem to be reserved for other treatments than prostate (lung, pancreatic cancer, and spinal cord). I think Mayo Rochester has one, but it did not seem to be available to me when I inquired about it for treatment of prostate cancer. Two commercially available photon units with MRI gating technology are available: MRIdian and Electra. Electra has larger margins 3-5 mm, which I'm not sure offers a sizable advantage. I'm also not sure what is happening with MRIdian. Mayo doesn't use them. The two nearest locations to me in Kansas City stopped using them. So if anyone has any information on the current status of MRIdian and the reasons that some institutions have stopped using them, post links for more discovery or how to find the current operating locations of MRIdian capable facilities.

Thanks as always for your support and guidance!