Thanks everyone for their inputs. If things workout here I will probably opt for Tulsa Pro though it is uncertain since they want to shrink my prostate size beforehand to get the heat level up as one lesion in the top back, and the shrinking may or may not work. I therefore have Mayo proton as a second choice, but it might happen if I don't get results with some shrinking using Dutasteride and Bicalutamide (Avodart and Casodex).

I had been on AS 2.5 years. During this years biopsy biopsy I was found to have a very tiny pair of bad biopsy lesions, this in addition to the original 3+3 lesion that again got a 3+3 on this biopsy. One very small new lesion is 3+4. The other says not enough tissue to fully grade the lesion, but it contains some 4 and since they don’t see 3 it is 4+4 but with a caveat listed that they can’t grade the lesion since not enough is present and it is a tiny lesion. So they all call it a Gleason 8, even though the biopsy report says not enough tissue to fully grade that one tiny lesion. Obviously I can't continue AS.

I don't like some aspects of opting for Tulsa with a Gleason 8, but it is a small lesion as is the other 3+4. Two tiny lesions. My PSMA shows no spread at all. Not sure I love Dutasteride and Bicalutamide, though exercise helps, and have to have a pelvis CT to see if it shrunk it a couple months.

Tulsa can always be repeated if something shows up later. Proton is spread over the entire prostate and not sure I love that idea. I don't think proton can be repeated. Tulsa less chance of ED, but sounds like many do ok on Proton. So we will see. It is 50/50 what will happen from here.

Thanks for the inputs.