I’m currently on BCR watch after prostate surgery last September. If and when I have a recurrence, I’ll need salvage radiation, so I’ve been doing a lot of reading and recently consulted with Dr. Amar Kishan, a leading radiation oncologist at UCLA.

He’s doing important work on improving the precision of radiation delivery, including real-time adjustments during treatment—such as pausing radiation if nearby organs move beyond a preset limit, and reducing planning margins. The goal is to better protect surrounding organs and reduce side effects.

One key takeaway from my discussion with him is that radiation tends to worsen pre-existing urinary symptoms, such as urgency, frequency, and post-surgical incontinence—especially in patients like me who already have these issues. Because of that, SBRT (which is currently only available post-prostatectomy as part of a clinical trial for salvage radiation) may carry a higher risk of side effects for some of us compared with conventional salvage radiation given over 35–40 treatments.

Bottom line: side effects depend heavily on the experience of the treatment team, the precision of radiation delivery, and a patient’s pre-existing urinary (or other) issues.