Why I am glad I chose Proton Therapy (for now). Good, bad and ugly.

My Treatment Decision Journey – Surgery vs Radiation (Proton Therapy Experience)

Making the decision about which prostate cancer treatment to pursue was agonizing.

When I was first diagnosed, my urologist made it painfully clear that surgery was my best—and essentially only—option. No other treatments were really discussed, other than a general warning that radiation had “lots of downsides.” Based on that, I scheduled surgery a couple of months out.

A few weeks later, I randomly ran into a guy who had undergone proton radiation therapy. He described minimal side effects, a fast recovery, and years later his PSA was still nonexistent. That conversation completely changed my trajectory.

I dove headfirst into research and consultations. I spoke with:
• Mayo Clinic
• UCLA
• A local radiation oncologist
• California Proton

The 5-treatment MRI-guided SBRT option was intriguing, but due to pre-existing bladder issues, I was advised that my body would likely tolerate longer-course radiation better. After a very thorough and reassuring consultation, I ultimately chose California Proton.

Before going further, I want to be very clear: each of us has to make our own decision, and we should support one another regardless of the path chosen. I am not speaking negatively about surgery—since then, I’ve met several people who are very happy with their surgical outcomes.

Diagnosis Details
• First diagnosed: May 2025
• Initial MRI: PIRADS 4
• Initial MRI lesion: 0.9 mm
• October MRI: upgraded to PIRADS 5, with lesion growth to 1.6 cm
• Biopsy: Gleason 3+4 = 7

That PIRADS 5 upgrade and lesion growth reinforced for me that this wasn’t something to watch indefinitely and that I needed to move forward with definitive treatment.

I had been on testosterone replacement therapy (TRT) for 9 months prior to diagnosis, and it had changed my life for the better. The idea of hormone-blocking therapy honestly scared me. All four physicians I consulted with told me I would not need to stop TRT, and I truly believe that helped keep my body stronger throughout treatment.

Treatment Experience

I temporarily moved to San Diego for what I jokingly called my “Cancer Vacation.” I won’t lie—75 degrees and sunshine near the beach helped my mental state tremendously.

I completed 20 proton therapy sessions.

The Good
Treatment itself was very easy.
My main daily challenge was bladder filling—I tended to retain urine, so I often had to sit in the bathroom and will more urine out before treatment.

The Bad
Around week two, urination became more difficult and painful. I started on Flomax, which was later increased to two pills per day, along with higher doses of ibuprofen. This helped, but only moderately.

I didn’t experience sudden urgency, but when I needed to urinate, it came in bladder spasms with very weak and stingy flow.

I also had several days of extreme exhaustion. My routine was to go to a CrossFit gym every morning, and I usually felt strong and energized. But by mid-day, I’d get hit with overwhelming fatigue—easily fixed with a solid nap.

The Ugly
About three and a half weeks in, I started getting gassy. One day, I stood up to urinate and realized my brain could not get my urinary sphincter to open—yet my anal sphincter would open without warning. I had to spin around quickly and sit on the toilet.

Gas would pass, along with very bloody mucus from my rectum.

For about two weeks, I lost the ability to control which sphincter would open first, so I learned to just go in and sit. I experienced intense rectal and bladder spasms, sometimes breaking into a cold sweat. The good news: it only lasted a few weeks.

Sexual Function

This was a major concern for me.

I take 5 mg tadalafil daily, which helps, and TRT has also helped with ED. For sexual activity, I may double the tadalafil dose, and it has worked very well—huge relief.

Dry orgasms are definitely an adjustment.

One Month Post-Treatment

I am now one month out from my last treatment:
• All rectal side effects are gone
• Urinary symptoms are much improved
• Still on double-dose Flomax, but planning to drop to one pill next week

We’ll see how the future plays out. Radiation side effects can appear 6 months, a year, or even two years later, so my fingers are crossed.

For anyone currently trying to decide what path to take—it is not an easy decision. I hope sharing my experience helps in some small way.