Hello Ed, I can answer this based on my recent first Psa test which has been 3 months since treatment. Below is my brief outline"
"Assessment/Plan
IMPRESSION/PLAN:
is a 68 YO male with recently diagnosed UIR prostate cancer. At least T2c. S/p biopsy with 4/7 cores positive. 3+4=7 GG2 disease. PSA = 9.3. DECIPHER: 0.34 LOW RISK
He is presenting today for consultation and second opinion.
NCCN guidelines for intermediate risk prostate cancer includes active surveillance, radical prostatectomy wwo pelvic lymph node dissection, external beam radiation wwo ADT, brachytherapy (HDR & LDR) wwo EBRT/ADT, and trial enrollment. The role and utility of radiation therapy in the patient's disease setting was extensively discussed. While no head to head comparisons between surgery and radiation therapy have been done, the breadth of data seem to indicate that similar rates of control are achieved with each therapy approach.

He is a candidate for MRgSBRT. The MIRAGE trial interim analysis indicated that MRI-guided SBRT significantly reduced acute grade ≥2 GU and GI toxicities compared to CT-guided SBRT, highlighting the potential benefits of MRI guidance in reducing treatment-related side effects.

The logistics of receiving radiation therapy was also explained. Prior to starting treatment, placement of fiducial markers and barrigel spacer for rectal sparing would be done first.

The benefit of spacer hydrogel placement was also discussed with patient for reduction of rectal toxicity.

Plan:
- we recommend MRgSBRT in 5 fractions
- Hydrogel spacer placement prior to RT
- he has low risk decipher and GG2 disease, and may omit ADT.

I had 5 treatment sessions on the MRIdian which MR_guided SBRT. My total radiation given was 42.5 gy over 5 treatments with NO ADT.
I had to use just two Flowmax 0.4 mg after the 3rd radiation treatment due to some diminished flow characteristics, that problem self resolved after the 4th radiation treatment and no further Flowmax has been needed. GU function has actually improved slightly to what it was prior to any treatment. GI some changes that include at times no time wait when the need to go is present. Before I could wait, but now go means go, if you know what I mean. GI can drip just a little now if I also wait when I know my bladder is full or getting near full, so I have just learned do not wait on these signals like I was able in the past.
My initial Psa prior was 9.3 and now 1st test after 2.4 which is more than I expected. I think yours is ok as well, because I was told after treatment by my RO, it's not the amount of decrease, but more of wanting to see a decreasing trend over time.