Decision time SBRT, IMRT or surgery

I am 59 yrs old and about 230 lbs.(was 244 when diagnosed). Gleason 3+4. I opted for the SBRT (scheduled in one month exactly). My PSA scores since october 2025 (4.38), dec 2025 (5.53), Feb 2026 (5.28), starting walking and light weights and lost 5 pounds. Most importantly, started eating the best cancer fighting foods I could research as effective. They found a tumor in my kidney while doing the petscan so I had to shift to that for a couple of months until they determined it to be benign (2 days before scheduled surgery!). Shifted back to the prostate and had a blood test on the day of my first Eligard shot (3 month shot) and my PSA was 3.53.
I didn't have too many side effects the first month but ended up getting hot flashes and weight gain along with the fatigue. I DID NOT push through it and keep on my walking regimen so I highly recommend not following that path if you can. I had some other stressors come up in life and had to travel a lot, as well. Excuses, for sure, but back on track now.
At any rate, finished the 3 month shot and just got my second one last weekend. PSA level at the time of the shot was 1.23! So, I am preparing for the surgery (spacer and gold chips) on Sept 8th and then will do the 5 radiation sessions the following two weeks.

The BAD: I got a lot of the side effects after about 1.5 months into the shot cycle. My reading told me that this is the peak time. Sinus blockage and pain on the bridge of my nose; fatigue;weight gain; my libido is non existent right now; hot flashes. good times! lol

The GOOD: I'm half way thru it! My PSA reduced enough to continue with the radiation therapy. I started walking again and lifting weights and I've dropped the added weight and am working my way towards the surgery goal weight in a month. I'm trying to get back to my eating regimen and a lot of the side effects have reduced (or Im getting used to them). Libido looks like a longer haul, from what I've read. Definitely a stressor on my relationship but doctor said this is my last Eligard shot...hopefully.

I think, like some here have already written, there is no substitute for preparing your body for either treatment...eat well and exercise the best you can. I'm back on track but I definitely failed for a month or so.

Good luck to everyone here!

Hello, my surgeon for the consultation is Dr. Edward Matsumoto from St. Joe's in Hamilton, Ontario Canada. He is the director of robotics surgery. Before this consultation, I meed today with Radiation Oncologist Dr. Nguyen from the St. Catherines Ontario. Once I get all the info from both consults, I will have to make the treatment decision. I seem to be leaning to robotics RP, but have concerns about the presence of Cribriform in the biopsy...Up here we don't seem to easily allow PSMA PET scans, which might help inform the treatment decision pathway...

OK, I am at a point that I need to make a decision and move on down the road. My first thought was surgery but with a abdominal aortic aneurysm, and COPD (fairly mild) I decided against that at this point. I have explored and continue to do so SBRT, and traditional long session radiation, as well as now Focal Therapy. The Focal Therapy sounded good but in doing more research I have found it to be still pretty new and maybe a step above taking the let's watch it approach with a pretty high chance of reoccurrence.

If I go down the SBRT road how bad are the side effects and what have some real life experiences been with you folks? The incontinence is the one that really concerns me and what quality of life would be if that was a long term issue.

@johnnyz

Very encouraging! Hope your decision is well guided and achieves superior outcomes brother! 🙏🏽

@harvey33
My brother at 77 had five SBRT radiation sessions. Three years later, he’s doing fine and his PSA is doing fine. He had some urinary issues that were solved by taking Flomax every other day for a couple of months. The hot flashes from ADT didn’t completely stop for about nine months, Now he has no side effects at all.

This is pretty normal for the side effects. Somebody has when they have SBRT radiation.

Rick Davis, who runs the ancan.org Organization with multiple meetings for prostate cancer patients, and other problems, was treated with five sessions of SBRT 17 years ago and has have no side effects at all for the last 16 years. Just to get an example of a long-term patient. He had a Gleason eight.

@jeffmarc

Thank You this is what I am looking for so please everyone keep them coming so I can at least have a data point from real life rather than a little of nothing that I have found doing hours of research

@harvey33
I had SBRT in 2023 on the Mridian machine which has a built-in Mri. The only other machine that has that is the Elekta Unity. I had no ADT. My PSA was 10.2 at its highest. I had five sessions. After the third session, I had to use Flomax for a few days or so which gave me relief overnight. No real side effects to speak of to this day, other than my erections are not as hard.