scj428: I had 3+4 Gleason. 10.2 PSA and was 69 when treated in January/February. I was diagnosed in October of last year. I looked at removal, different forms of radiation and tulsa pro/ablation.... I spoke with 5 radiation oncologists from at least 3 centers of excellence.

I too had the Decipher test and it was one piece that was definitely used by the doctors and me to help with our treatment decision.

Removal was not right for me as I did not want to deal with a 20-30% of biological re-occurrence. I was also willing to rule out, or make removal more difficult later on. Tulsa Pro and ablation statistics were not robust enough for me to decide for that type of targeted treatment. I felt the same way about cyberknife, though it has been out longer, so I focused on radiation.

I looked at Proton and narrow margin photon machines. The process of radiation usually involves radiating the entire prostate and 3-5 mm outside of it to cover any possible microcell spread. Anything that narrows that margin to limit healthy tissue exposure, and therefore side effects is important. Most of the radiation treatments used margins of 3-5 mm. The margins on the photon machine I used was 2 mm. Thats a BIG deal (2mm vs 3-5mm) and I had 5 hypo fractional treatments. The MIRAGE randomized trial also showed how important real time, while on the table, MRI imaging is versus fused images. Again, PROTECT HEALTHY TISSUE by choosing reduced margin treatment if you choose radiation.

Proton was a choice that I strongly considered because of how the radiation exit could be stopped and its narrow beam but it did not have real time built in MRI. There are several MRI guided machines to use on the market now but NOT for Proton.

I also had spaceoar inserted to give separation between my rectum and my prostate, to minimize healthy tissue exposure. There are several spaceoar type gels on the market as well as a fairly new saline into a narrow disappearing ballon insertion.

You will see on this site that most were happy with their choice and treatment. I too would not do anything different except I would have a fusion MRI. I had restricted urine flow after 3 treatments but Flomax helped reduce that within a day. I had no bleeding and no pain and am still that way. PSA has been going down with each blood test every 3 months. No ed issues either.

Feel free to private message me or ask here if you have any questions.