Proton Therapy: any long term side effects? Any regrets?

I'm considering proton radiation maybe sometime this fall, I'm 72 and was diagnosed a year and a half ago January 2024 with Gleason 4+3=7 but so far have done nothing but just monitor my PSA which recently went down from 6.44 to 5.29 I am on a zero sugar diet, I feel great, no symptoms whatsoever from the cancer. Surgery was ruled out for several reasons, so Mayo was recommending radiation. I am just not mentally prepared to deal with any side effects. I am also looking at Tulsa Pro, does that require SpaceOar? I am hoping that they continue to improve the treatment options, and eventually come up with one that has zero side effects. Maybe I'm just trying to run out the clock

Once you have an intermediate unfavorable Gleason score, that’s more of a driver than a fluctuating PSA (unless the PSA is very high).

Other factors to consider in your decision:
> With your 7(4+3), does your biopsy report indicate the %4s and %3s? If the %4s is very high, continued waiting is suboptimal.
> In the MRI or biopsy reports, were the words cribriform pattern, extracapsular extension, seminal vesicle invasion, perineural invasion or intraductal carcinoma mentioned? (If not, that’s good. Some of those terms are indicators of more advanced disease.)
> Whst were the results from your Biomarker (genomic) & Genetic (germline) tests?
> What were the results from your PSMA PET scan?

With all that information, you’ll be more fully equipped to make a treatment decision…. hopefully, soon.

Prostate cancer is usually asymptomatic so, your “no symptoms whatsoever from the cancer” is good, but typical.

SpaceOAR is used to protect the rectum from excess radiation. TULSA-PRO uses ultrasound energy to heat and destroy prostate tissue,

At 65y, I had 28 sessions of proton radiation (during April-May 2021) and 6 months of ADT (Eligard) for a 4+3=7. Treatments were relatively uneventful and I’ve had no lingering negative after-effects. (With all the data I read, proton’s Bragg-Peak characteristic was persuasive.) I have no complaints regarding my proton radiation treatments.

With proton radiation, instead of looking at the “possible” side-effects, look at the “likely” side-effects. You’ll find that (if you take the available precautions) there are few and the risk is low.

Good luck!