Many of us have told their stories here, rshap1031. Seriously, search and you will find. Oftentimes, Moderator Colleen will help you get on track to the answers you seek. I have never shared my tale, but will now since my history isn't too far off from yours.

In April of 2022, my annual exam showed my PSA jumped two points to 5-point-something. Before that, the increments were only tenths. I got an MRI, had a fusion biopsy, and on July 11 received my diagnosis Unfavorable Intermediate Localized PCa, (4+3) Gleason. My Omaha urologist listed all of the options and I was initially like others on this site - Cut this crap out of me! I don't want it in me.

But I thought I should at least hear about radiation, so I booked a consultation. In the meantime, my mind thought of being treated in Omaha at one office here and another institution across town and I thought of Mayo, six hours from me. Everything I'd need is in one complex and I had a family member who'd been successfully treated for a worse cancer, so I figured I'd be crazy to not contact them.

Video consults were booked out pretty far, so I got my first consultation in August by driving up. That was with a surgeon and he was very confident he could get all the cancer. I was all set to go with him until at the end he told me this, "Given your age, there is a 50-50 chance of incontinence." That blew me away and I asked if I could see a radiology oncologist. I was able to see a doctor for that only two days later because of a cancellation.

After seeing him, I was at your crossroads, but for me it was incontinence vs hormone therapy. I hated the thought of drip-drip-drip, but I loathed the thought of ADT's side effects. At first this doctor thought five proton beam treatments and 18 mos (I think) of ADT. I thought I could live with that and would have gone with it, but he changed to 20 Tx and longer ADT after a Mayo radiologist looked at my MRI. I was back at the rock and a hard place.

I found another doctor (still at Mayo) and got a video consultation with him. He was confident that I would be okay with only the five treatments and - bonus! - he required only four mos. of ADT with a six month PSA follow-up. I was sold and asked immediately to be put into the program.

I was in Rochester October 9 to November 13, 2022 - five weeks. Week 1 was just some basics; Week 2 was all the prep work; Week 3 was the team's planning time; Weeks 4 & 5 were the five treatments.

The side effects of ADT didn't perceptibly start until two months after the shot. Initially, it was a sporadic hot flash. Now, 3½ months later, I'm running the gauntlet of effects - more frequent but not irritating flashes, muscle loss that pees me off, and, maybe, some lethargy and depression. ("Maybe," for the latter two, because there could be other contributors.) Libido is nonexistent, but I can still muster an erection. I'm single, so I can't testify honestly to the success of my arousal. On the plus side, I'm not incontinent, in fact have better control than before, and I can pee freely, woohoo!

So far, rshap1031, I am okay with my choice. I'm waiting to see how long after four months these side effects persist. Also, ONLY four months is not in stone. Depending on PSAs, I could well be put on it again. What I wonder, though, is where your four years of ADT is coming from. There are guys on this site who've been on it a long time, but usually that is after they get detectable PSA readings. I can't recall anyone saying they had to do four years right after treatment. Maybe it is Second Opinion time.

Finis. I hope you find some help here, rshap. As I said, there are many stories like mine on this site. My first read was @dandl48 and I ended up following his path. Last I read, he is still doing well. I've been working on this for hours now, so I'm probably the 10th reply by now. Oh well.

David D