@fritzo I wouldn’t choose cryo for my primary treatment either - too many unknowns. But, for a recurrence which might be a single solitary lesion, cryo (or brachytherapy, or SBRT) might be an option for salvage treatment because they’re very targetable.

Yes, salvage radiation after primary radiation carries risks, especially to rectal tissue (which doesn’t tolerate radiation well). For that reason, I chose proton radiation that, due to its Bragg-Peak characteristics had little entry-dose, scatter, or exit-dose - so is unlikely to hit the rectum. (See attached Bragg-Peak graphic.)

And just-in-case, we used the SpaceOAR Vue rectal spacer that reduces by 70% any radiation that might approach the rectum. (See attached graphic.). That leaves my re-treatment options open in case I need to consider it later. (I know two guys who had repeat SBRT because their recurrence was just a small lesion.)

Also, if they’re skilled enough not to overshoot the prostate, there’s little risk of bladder/bowel injury. Again, that’s another reason I chose proton radiation that, due to its Bragg-Peak characteristics had little entry-dose, scatter, or exit-dose - so is unlikely to hit nearby, otherwise healthy tissues and organs. And I chose a proton center that were specialists in treating kids’ brain tumors. My thinking was that if they can hit a pea-sized tumor deep in a kids’ brain and not cause any surrounding brain tissue injury, they can certainly hit a walnut-size gland and not cause any surrounding tissue injury.

He’s right, follow-up hormone therapy doesn’t kill the cancer. But the doublet therapy combination of an ADT (Eligard, Lupron, etc.) + an ARPI (Xtandi, Zytiga, etc.) will starve the prostate cancer, interfere with its androgen receptors, and weaken it so much that other cancer-killers used will be more successful.

If your doctor won’t order a genetic test, or your insurance company won’t pay for one, you can get a free genetic test here: https://www.prostatecancerpromise.org/