@pamperme Hey bud, I agree with the comments of @jeffmarc. Treatment for recurrence does seem inevitable due to the big jump in PSA over 6 months and other factors in your pathology.
Your history of pudendal nerve issues certainly gives cause for concern; as far as radiation exacerbating bowel issues, you really need to sit down with the RO and see what can be done. Unfortunately SRT is not very precise when compared to other forms of radiation (SBRT) but beams can be shaped to avoid delicate structures.
As for ADT, I would lobby for Orgovyx - an oral medication which for me and many others does not have the marked side effects of Lupron. I took it for 6 months, had minor symptoms and recovered very quickly from it.
Trust me when I tell you that all your anxiety and fears about ‘what ifs’ are worse than the treatment. And remember, an oral med can be stopped if necessary and radiation treatments can also be paused or stopped if symptoms are intolerable.
Long range side effects are variable and mostly unknown so we all roll the dice when it comes to making this decision…Best,
Phil