At 65y, I had localized prostate cancer, PSA of 7.976, PIRADS 5, and Gleason 7(4+3).

After spending much time analyzing all treatment options and interviewing specialists, my choices came down to (1) proton, (2) IMRT, (3) SBRT, & a distant (4) surgery.

I chose 28 sessions of proton beam radiation + 6 months of Eligard.

We discussed what we would do if I had a localized recurrence, and depending on the nature of the recurrence, there would be choices of: focal therapy (e.g., cryo), brachytherapy, SBRT, and yes even re-radiation (since we were using SpaceOAR). Surgery would be a last (nuclear) option for salvage treatment just as it was for initial treatment.

There is rarely a “one and done treatment” for prostate cancer so, I wouldn’t focus on that too much.

My 28 Proton radiation treatments + 6 months of hormone therapy had no impact on sexual activity, incontinence, or outdoor activities.

Good luck with your decision.