What do you think comes next for me?

@heavyphil
Thanks for the information, Phil. It's good to converse with someone who has been treated with the treatment I am interested in. Did you experience any side effects?

@kevinm4 - 20 sessions of IMRT Oct 2025. Hardest part was the full bladder, empty bowel requirement. You want to practice this a week or 2 beforehand if you choose this route. The only side effect I maintain now is that when my insides signal I need a bowel movement, I need it now. There is very little lag time between the signal and the action. Luckily, I have this down to immediately following morning coffee so there is no disruption during the day. During treatment I needed to stay away from spicy, greasy or it would not be a good day.

@kevinm4 Very minor, Kevin; about 10 days of increased bowel movements only at the end of treatment. All good after that. No urinary issues at all.
It is VERY important to follow empty rectum/full bladder protocol to minimize SE’s.
My RO and his team stressed this every day! Best,
Phil

@kevinm4 First should get Decipher to see how aggressive the cancer is (done with biopsy material). If you decide to consider IMRT get the standard Prostox test. This is a germline (good for life) genetics test that will indicate if you are likely (>75%) to have long term side effects from IMRT (from 20-45 fractions). The 88% that pass Prostox have an 8% probability of long-term side effects.

To minimize side effects (past Prostox) make sure the facility has good equipment to provide IMRT/IGRT/VMAT so that positioning is dynamic, and lots of beams are used that go 360 around your body. This minimizes exposure to the rest of your body and therefore minimizes side effects. Some on the board claim MRI is best but I did not have side effects from CT positioning. It is also peaceful since MRI is loud. Positioning on the table that approximates the target (final targeting is done by the machine) takes as long as the treatment. Each treatment is 2-3 minutes depending on how many Gys are being delivered (1.8-3.0) and you need to be still so the dose is delivered correctly, and the machine does not stop (safety feature if off target). All beams will intersect at the prostate and it will be fried at conclusion so dry orgasms. I had sexual function as soon as I got off ADT (you should not have ADT for 3+3 or even 3+4; at 4+4 I had combo treatment). I did have urethra constriction and was prescribe Flomax and them Gemtesa after treatment. With the medication the amount of urine I passed went from a decrease of 50% from pre-IMRT to an 100% increase after with medication (did not realize effect of BPH). Scaled back and got off Gemtesa. Substituted low dose Cialis for Flomax due to a better side-effect profile (dizzy and high pulse rate). So minor urgency, capacity, and flow effects pharma made better than before IMRT.

Thanks everyone for all the information. I will copy all of it for the future, but for now, after speaking to my doctor this morning I am now on active surveillance. My surveillance consists of PSA in 6 months, MRI in 12-18 months and initial re-biopsy in 12 months, otherwise a biopsy could be 12-24 months after that. I also asked about the Decipher test and she said she would submit it and only order it if insurance covered it. Again, I appreciate your help and guidance.