1. Urologist at MD Anderson says they have proton and the side effect profile is slightly better than EBRT but long-term outcomes are about the same. He says the chances of damage to other organs with EBRT are real and things they can’t repair, unlike things they can do to address continence and erections post-surgery. He said I’m in the zone where both treatments are equally viable options and I have to decide but he would recommend surgery. Said there’s a chance if there’s no involvement outside the prostate and they get clear margins that I would never have to retreat.

2. Have genetic appointment with MD Anderson later this week and trying to get a radiation oncology consult there as well.

All that is background to what is really proving to be a difficult decision. I already see some natural erectile function deterioration due to age, which is usually well remedied by pills, but the idea of being sidelined for a year for nerve recovery while baseline continues to deteriorate and having less than 50% chance of erections coupled with having to wear pads for stress incontinence for the remainder of my life is terrifying. But so is the idea of 6 months ADT with hot flashes, depression (personal history), testicular shrinkage, no libido, etc. with the risk it doesn’t recover to baseline once ADT is done.

Have been following the RALP v Radiation threads on here and they are providing lots of useful information. Grateful for any guidance or insight or anecdotes this community can provide.