Hi Steven,
I opted for proton therapy combined with 2 years of ADT (lupron + abiraterone + prednisone). To arrive at that decision, I invested quite a bit of time doing research and writing down my questions as I went. At diagnosis, in the fall of 2021, I was 67 and in otherwise very good health. I based my treatment decision on the most recent results out of the Stampede Trial which indicated that the treatment I chose would provide comparable overall survival and progression free survival to surgery plus radiation plus ADT (the other treatment path for high/very high risk prostate cancer) without the risks of surgical side effects. Since then, there has been more research into the efficacy of radiation vs surgery for cribriform which you should research then ask both a radiation oncologist and genitourinary urologist about.

I am very happy with my decision. In consultation with the radiation oncologist, surgical oncologist, genitourinary medical oncologist and and my primary care doctor (who continued to monitor my health on a regular basis through treatment), my team at the UW Medicine/Fred Hutchinson cancer center ( they use a multidisciplinary team approach to new patient orientation), the majority opinion was to take my chosen path.

I chose proton instead of photon because the RO felt that due to my one hip replacement and location of the EPE that it would result in the most effective treatment and reduced risk of both short and long term side effects. To date, I have had no side effects from the radiation nor did it impact my life during treatment. The results of the Stampede trial strongly indicated that the lupron + abiraterone combination therapy would provide the best long term outcome in conjunction with the radiation therapy (RT). As Jeff suggested, there is no reason to fear ADT. It did cause the usual side effects, but they were manageable with a healthy diet, regular cardio and resistance exercises and sleep (yes, I did find a lunch time or afternoon nap very helpful when I could adjust my schedule to allow it). I live an active life. I am a general contractor and spend my free time hiking, mountain biking kayaking, xc skiing and snowshoeing. We continued all of these activities during treatment although my energy levels and stamina were somewhat reduced. By six months after completing ADT, my energy and physical conditioning had returned to pre treatment levels. During ADT, I did experience some temporary changes to my emotional state from time to time which were occassionally annoying, but facinating to experience none the less. Libido evaproated which was a big change , but gradually has returned to normal. Post treatment, physical intimacy is just as enjoyable as ever,

For me, accepting my diagnosis, determining that what was most important to me (striving to live in the sweet spot where quality of life and longevity coexist), finding a medical team I had confidence in, educating myself, on an ongoing basis, about PCa (which allows me to have confidence in and effective communication with my doctors) and making the most of each and every day I have because there is no guarantee of tomorrow (nor has there ever been) are the steps that I followed to get to where I am today.

Life is good, even during this whole PCa existance. but attitude and continued effort to keep life well balanced is what makes it so for me. I wish you success in your journey and am glad that you found MCC. It is a great help.
Bill