kjacko: I had 3+4 as well last December with a 10.2 psa. I am 70. I had multiple opinions from radiation oncologists and narrowed down my radiation choice to either the Mevian proton therapy or the MRIdian Linac machine from viewray. For me, prostate removal was not a viable choice as I considered the quality of life risks to be too great. I had the decipher test which measures aggressiveness and IS used by doctors as one component of decision making so you may want to ask about that as well ass the specific radiation machines.

You want to protect healthy tissue so it helps to ask about the margins used in treatment (the mm outside of the prostate that radiation will expose healthy tissue to). The MRIdian uses 2 mm vs others that use 4-6 mm. I had 5 hypo fractional treatments and finished them in February. Most of the Dr's say the same thing which is that the outcomes are the same regardless of your choice with tolerable side effects. Every person is different so ask about the specifics of side effects, i.e. urination issues, use of Flomax to help relieve urination restrictions, bleeding and discharge from the anus, treatments you are restricted from because of a large prostate, what are the dr's PSA expectations after treatment, does he/she recommend spaceoar for treatment (separates the rectum from the prostate by 1/2 inch), to name a few.

There is a lot to ask but take one step and one day at a time. Keep coming back to this Mayo Connect site as there are lots of experiences and detail from real live patients. Use the search function to find more about treatments discussions. Get second and third opinions. Dr's are devoted but not infallible and cancer can be unforgiving.

Keep researching:
Nccn.org
Many doctors follow their guidelines, and it is there for doctors and patients
Decipherbio.com
Takes a slice of the biopsy which helps evaluate aggressiveness and modes of treatments
Viewray.com
MRI/Radiation machine combination unit
Mevian.com
Proton therapy radiation machine
PCRI.org
The Prostate Cancer Research Institute helps men and caregivers research their prostate cancer treatment options