@biggalew Some do to a greater or lesser extent. After 25 rounds at Sloan I had diarrhea for about 2 weeks; it left and never returned.
Zero symptoms in the bladder department.
Every session my team stressed the mantra: empty rectum, full bladder. They promised me no lasting SE’s if I followed their directive. So far, so good!🤞
The only other thing I’ll add is that you should start ADT NOW. Your PSA is elevated and you want to STOP it from getting higher and risking further spread. Once it gets past your nodes, it will become much, much harder to contain and treat…it’s that simple.
Maybe you have things going on in your life right now, which makes you want to wait for the new year – and believe me we’ve all been there! Nobody wants ADT and we try anything and everything to delay it for as long as possible.
But this is your very LIFE we are talking about here and nothing is more important than that. Best going forward,
Phil

@biggalew I had almost no issues. A little loose stool (but no diarrhea) during the treatment (helped with the empty bowels / full bladder requirement). No rectal spacer so that was same as salvage RT. The bladder requirement for salvage RT may be different than the primary treatment I had. I had a little urinary urgency for a few months (pills to suppress this) after treatment but no incontinence. Most have no problems except for the urethra being squeezed if primary treatment due to massive RT hit on prostate (usually resolved with Flowmax). The key is to go to a center with good equipment and image guidance. As long as the radiation goes to plan (these are developed to minimize the hit on rectum and bladder) there are usually no problems. It is important that they are on target.

@biggalew
My husband is finishing his salvage RT (only 3 more sessions planned) . He had everything radiated - nodes, prostate bed, pelvic floor plus nodes boost. He has zero SA 🧿. His machine was VMAT and he had golden fiduciary markers placed, no spacer (spacer is almost never done for salvage).

I made sure that he had good diet and was really hydrated . He was taking fiber (inulin plus Metamucil) every day and also probiotics, L-glutamine, slippery elm, and ate chicken home made soup every day. He had no trouble keeping rectum and colon empty and his bladder 95-100% full - this is very important. They told him that he is really among very few that they treated who had bowels truly empty and with no gas. His RO and the whole team were really glad that he had no SA considering that so much of the area was covered with RT and one of the nodes was mesorectal.
We hope that it will stay that way since some studies indicate that strong acute reaction is correlated with presence of later appearance of chronic side effects but only time will tell.🍀

Wishing you all the best and I agree with others, please start at least with ADT ASAP.