ART / SRT side effects please

Hi team:

Anyone who has had ART/SRT, or can post a link, what am I looking at in terms of impact on UI (Urgency and Leakage) and ED? I have basically scored a free pass so far. Do I keep that or am I looking at trading it in to keep this thing managed? And what RT modality is best for ART/SRT?

It is beginning to dawn on me how bad my pathology was, mainly the IDC-P. I have found papers that compare it to GP5, it's supposed to get to CRPCa sooner, be more radiation resistant etc. Real hair-curling stuff. I have found another paper that shows however that ART can get on top of it (I can post links if anyone cares). So I have to have some serious conversations about RT. It's probably time to retire the (really outstanding) surgeon, who will have bias ("But, I don't understand: I've cured you") in favor of an onc. or, biting the bullet, an RO. (London recommendations welcome!)

open-minded views welcome. I will block anyone who starts a radiation v surgery war, tells me surgery was a mistake, tells me it's all mental etc. (I will tolerate PSMA fanatics but it will be basically OT: unless something really odd has happened I will have < PSA.) I want FACTS in the form of experience or research links that show me MY tradeoff in terms of survival benefit (not BCR, PCSM: it would be odd to have RT in order to avoid RT!) versus side effects.

ShawsMan - That intraductal carcinoma of prostate looks to be a wild card issue, separate from the parameters we usually look at. I would be inclined to get a second opinion on the pathology from someone like Dr. Epstein (or equivalent in London) that has experience with IDC-P to know exactly where you are at. Then I would seek out a urologist, oncologist, and radiation oncologist who professes to know about such things and see if you trust any of their opinions.

Take a look at the Cleveland Clinic calculator where you can toggle ART on and off for a baseline https://riskcalc.org/prostatecancerpredictingpostradicalprostatectomy/

I am 3 years past RP and almost 2.5 years past ART. I was continent after catheter removal and have ED (partial nerve sparing on right side). ART did not change either of these items. Uro and RO both said that ART can aggravate urinary and ED recovery if not fully recovered. Had return of urgency at the end of ART and for a month or two afterwards. It was like a repeat of the couple of months after the catheter was out.

IGRT/IMRT is used for ART and SRT. My RO was pretty clear that was the only option when I asked about shorter options. It is a cleanup operation which spreads the radiation around where the prostate was. The goal is to not create side effects while slowly killing the cancer cells thus the low daily dose 1.8Gy/session) over 7-8 weeks seems to be the current practice.

Also an intraductal guy - ART and 24 months ADT.

ADT mat affect incontinence because muscle loss and erectile function. ART may affect continence and ED. It depends on the field size. If they do whole pelvic more tissue is blasted vs just the prostate bed. Dose can be factor as well.

If you have BCR, 33% chance is in the pelvis, 50% it is elsewhere, 17% it’s in pelvis and elsewhere.