@jeffmarc My prostate was measured by MRI at 62 cc. The RO says his usual cutoff is 50 cc, but 60 is acceptable by many. Its not like it is 100 or more, which Stone says is fine.

My prostate has a fairly large tumor in it, that can be expected to shrink now that I'm on ADT.

I don't know anything about TURP, i.e. is it a problem if the re-sectoscope chews up cancerous cells, etc. My urinary status is something I've been living with, that is, a very weak flow, often it takes a while to start, and I have nocturia - getting up every 2 hours to relieve myself. The RO had no interest in details, he just looks at the IPSS score. I can't find the one he has - perhaps it is in my desktop computer I'll be able to see tomorrow.

I've decided I'll be getting a second opinion unless my RO contacts me saying he's decided I qualify for EBRT + BT.

Re: your wondering about why several docs you've heard about, i.e. my RO and the doc for the guy you heard about or met who got turned down for BT based on the size of his prostate, anyway, why do the Europeans and others find larger prostates to be no problem, whereas at least some US docs do?

Note that the European document updating their criteria that I cited was published in 2022. They cited research papers from 2013. So it took them that long to decide what to do once the research was public. In Europe BT use is expanding, so there isn't a widespread feeling that it isn't any good even though the data clearly indicates otherwise. So in the US, where BT is regarded by many as a dying art with large advertising budgets devoted to promoting protons, cyberknife, etc, there may be less interest in updating guidelines.

Also, when I needed a heart ablation some years ago, I was aware there was an advance in the equipment available. A heart ablation to deal with a-fib involves sending a probe into your heart via a vein and killing cells in certain areas to stop the errant electric signals causing the heart to beat improperly. So the US approved instrument used heat, and depending on the skill of the surgeon, a low %, less than 1% of patients could find that they had a hole burned through their heart and into their esophagus, i.e. they might be dead. The new instruments used, I think it is electro poration, did not kill patients in this way. The Europeans had adopted it by the time I couldn't put off my procedure any longer, the US had not. Some US centers were running clinical trials where a patient could get a surgeon using this. I found a local guy who had 500 procedures under his belt and my procedure was a complete success with the older more dangerous tool. US guideline creators can be too cautious, not cautious enough, or just big doofuses (why did they say in 2012 PSA should not be used as a screen?) or really good.