@jimcarr Ask your radiation oncologist if you are a candidate for the SBRT that Jeff alluded to. It is only 5 sessions over two weeks. I had it 2 ½ years ago. Side effects were minimal and at this point both my radiologist, and urologist are thrilled with the results. The SBRT would be unlikely to cause you problems that would require assistance.

@jimcarr Except for HDR (brachytherapy) which is done in the hospital under sedation the radiation is usually not debilitating. I had external beam radiation 5x a week. Routine was to get up exercise, get dressed and drive to hospital for radiation treatment, then go to work. I did that every day. In the last half of the treatment may get urgency, reduced flow, loose stool, etc. Can be resolved with a few pills Flowmax, etc. You should be fine at home. If you chose EBRT there will be multiple courses available from SBRT (5 treatments) to 20, 28, and 35+ treatments. Fewer treatments usually have more short-term side effects. Also, Proton (if VA covers) vs. Photon. In all cases get IMRT/IGRT which is what should be available in SF.

With large cribriform the RO will probably want to put you on ADT. Get Orgovyx (needs approval for VA) since that is a daily pill and if you have bad side effects it can be stopped. With the shots (Lupron, Eligard) you in for at least 6 months even with a 3-month shot since it takes 3 months to recover testosterone. I had no side effects on Orgovyx. Short courses are about as effective as longer ones for localized cancer.

If choosing surgery, ask about the likelihood of a BCR with the high percentage of type 4 and cribriform. Even though the PSMA PET was clean it cannot pick up small metastases. With EBRT the pelvic area is likely to be treated based on your biopsy to take care of these. With surgery if it is outside the prostate, it will cause your PSA to increase (a BCR) and you will need salvage radiation likely with ADT. Did they do a Decipher test on the biopsy? That will provide a score that can help with the decision.

@jimcarr
Radiation does not normally leave you in that kind of situation.

I had 40 sessions of salvage radiation and went to work immediately after every time and didn’t have any side effects at all for six years, then I started to have some incontinence issues.

My brother at 77 had SBRT radiation. More than an hour and a half ride back-and-forth on the bus and he had no problems at all doing that. The worst he got was he had some urinary issues burning, Flomax resolved that.

A your age, you can do SBRT radiation, Five sessions and it’s over. If you could get to UCSF, I can recommend A radiation oncologist that you would like a lot.

If you really do have seminal Vesicle invasion then they may want to put you on ADT, That would be more troublesome than the radiation. Still no problem driving after the procedure.

If you have to have IMRT radiation for 20 sessions, Or more, it can cause urinary and rectal issues, Some people get diarrhea, which can be a pain, keeps them near a toilet. This doesn’t always last the whole time, however, The body can usually adjust to it.