@wwsmith Great question for any of us on this forum! My treatment goals were determined by my own personal experience dealing with cancer among my siblings and parents over a 50 year time frame. What I saw was quality of life, and death, caused not by the cancer but by the very treatment that was supposed to cure them.

My personal goal was ensuring QOL not 5 or 10 years down the road, but 15 or 20 years down the road. I helped my Dad struggle through his prostate treatment side effects that showed up 20 years after his treatment, and was not how I envisioned the end of my life to be.

Statistically, all modes of treatment have the same cure rate. I am comfortable that my cancer could be put to rest; I was seeking the treatment that would provide the safest experience for a long life and protect me from the inherent dangers of the treatment itself. I evaluated surgery, IMRT & SBRT , Proton Beam, cyberknife, "radioactive painting"of the Prostate (a term coined by Proton Therapy, but really applicable to IMRT and SBRT too), and all the safety modes including spacers, low dose-long rad vs High dose-fast rad, and the newest technologies using adaptive radiation treatment.

Given my disposition, age, physical condition, tolerance for wanting to deal with side effects, and a huge consideration for internal karmic feelings, my treatment mode will use CT Scan Adaptive Radiation with real-time x-ray tracking. I chose 28 days vs 5 (smashing your fingers with a hammer vs hitting your fingers with a soft rubber hose). Using the latest technology in spacers, Bioprotect, which provides more space than SpaceOAR between the rectum and prostate and is also saline filled to absorb some of the rad dose to the rectum. My treatment plan includes radiation sparing lower dose to my urethra and distant seminal vesicles, and a focal boost in radiation to my lesion.

This is just what felt best for my goals and concerns, your selection will be personal to you and your own situation.

I started Orgovyx last week and now I have to sign off so I can get to my first Rad Treatment this afternoon.

Best wishes for all to make good decisions for their own best outcome!