Radiation vs surgery: What criteria did you use to choose?

@rsprehn

I was 69 when I was diagnosed in 2022 with 3+4 and an 11.2 PSA. I looked into removal and radiation. My focus was side effects and quality of life.

For me, removal had too many possible side effects even with the most skilled doctor available. There are certainly many stories on this site regarding its success for some but the risks were not for me and many seemed to come back later for radiation (%'s seemed too high and too many stories on this site regarding that).

In my research, radiation became too much of a catchall term (even today on this web site) so I drilled down into types of radiation and radiation machines. Not all machines have the same results in terms of toxicity/side effects. I narrowed things down to the Mridian machine (nowadays also the Elekta Unity machine) or Proton therapy. I did understand that once you are treated with radiation for your prostate, you can't be re-treated.

Although Proton therapy has a dosimetrist that calculates how far the beam penetrates before it stops, I went specifically with the Mridian machine. The Mridian machine has a BUILT in MRI versus non-MRI machines that used fused images for treatment. Also, the standard for radiation treatment was/is to treat the entire prostate plus a "margin" around the prostate which for most machines, including proton, was 3-5 mm. The Mridian uses 2 mm which to me meant half or more as much healthy tissue exposure which impacts toxicity/side effects. This was proven in the Mirage randomized trial which showed significantly lower side effects and toxicity for a radiation machine with a built in MRI versus non-built-in MRI machines. Here is a link to urology times talking about the study:
https://www.urologytimes.com/view/mirage-trial-margin-reduction-with-mri-guided-sbrt-reduces-toxicity-vs-ct-guided-sbrt
I finished 5 hypo fractional treatments in February of 2023. There was no ADT involved. I had slight urine flow restriction after the third treatment which Flomax took care of overnight. Orgasms were not as intense, sperm was less and thinned out a bit and my urine flow over time actually improved. My RO told me I might only have urine flow at the level it was before I had radiation treatment so I have been pleased and relieved.