I was initially diagnosed at 56y/o with a localized 6(3+3), and was on active surveillance for 9 years, giving me time to evaluate all treatment options.

At 65y/o, with a localized 7(3+4), I chose proton radiation (28 fractions @ 2.5 grays/fraction). Prior to starting treatment, a second opinion upgraded the 7(3+4) to a 7(4+3); we simply added 6 months of Eligard.

The proton radiation treatments were uneventful. My wife later told me that if she hadn’t known I was undergoing radiation treatments, she wouldn’t have realized it from any change in me. (That’s how benign this process can be.) I’m now 5+ years post-treatment.

Prior to starting ADT my medical oncologist recommended that I ramp-up my weightlifting regimen (or any load-bearing resistance-training program) to minimize the known side-effects of ADT. Already a gym rat, that was easy to do. As a result, I only experienced muscle atrophy, low libido, and mild warm flashes. But, I avoided the common ADT menopausal-like side-effects often mentioned: forgetfulness, confusion, memory loss, mood swings, emotions, fatigue, ED, insomnia, hot flashes, night sweats, and more…. (Though my wife did tell me that I started watching way too many Hallmark Channel shows!)

> curious as to why with just a 7(3+4), they’re recommending ADT (Orgovyx) for you? That’s uncommon for intermediate favorable disease. Have you had an ArteraAI prostate test? The results will tell you whether or not ADT will be beneficial.

> have you had any other biomarker (genomic) tests?

> with your 3+4, what % of that is “4”? That matters in the treatment decision.

> did your MRI or biopsy reports mention anything about cribriform pattern, extracapsular extension, seminal vesicle invasion, perineural invasion or intraductal carcinoma? (If not, that’s good.)

> do you plan to use a rectal spacer?

The key point with any external radiation treatments is for them to not overshoot your prostate. If they can avoid overshoot, you’ll be in great shape during and afterwards. Despite proton’s Bragg-Peak characteristics as it relates to prostate cancer treatment, they still can’t lazily overshoot your prostate; you need to work with them on this important issue.