So glad you are working with a center of excellence and looks like you are approximately where I was at - Gleason 7 (4+3). As you found, PSA alone is not a definitive indicator of PC, doubling time and slope of increase are also very important.

As you have seen on this and other forums, no procedure will absolutely guarantee the prostate cancer is gone forever. The medical community has developed a lot of indicators/tests/etc., but nobody knows if the cancer has been contained to the prostate, even if a full pathology is performed post radical prostatectomy. However, in my view, the best indicator is a physical examination of the prostate, seminal vesicles, lymph nodes, and any other tissue removed. Scanning tools and biopsies are good indicators for the existence of cancer, but at this point in time, can't define margins as accurately as a physical pathology. Also, when the prostate, seminal vesicles, and several lymph nodes are removed, all known cancer is out of your body.

I am always skeptical of statistical data used to justify less invasive procedures for addressing prostate cancer. These studies almost always use a 10-year outcome/survival rate/etc. to justify their procedure. What I always ask myself, what if I want to live longer than 10 years? I use the the analogy of laying out landscaping in your yard. My wife and I are meticulous and have in the past laid out the placement of trees/shrubs based on maximum size defined on the grower's label. Every time, the plantings would grow together. It took us two 10-year cycles to realize that the maximum sizes are based on 10 years of growth. So, when we laid out our landscaping based on the grower's label, the plantings ultimately grew together. This is a silly analogy, but shows the limitations of a 10-year study.

Bottom line, do as much research as you can to ensure the treatment procedure aligns with your life goals and expectations. i.e. If impotence is something you absolutely cannot live with, then maybe a less invasive procedure is worth the risk. For me, 30+ years of cancer free life was #1, #2, #3, with continence #4, and erectile function #20. Fortunately, up to this point (only 1.25 years post RP) I have been blessed with good outcomes on all of the above. I chose a center of excellence (Mayo-Rochester), went with the best possible doctor at that center of excellence, and did all of the physical therapy required pre and post surgery.

Good luck and hope all goes well for you addressing your prostate cancer!!

Jim

I also was a 4+3 in 2 cores and 3+4 in two out of 30 cores. My prostate must be bigger than yours but my PSA was only 2.9 and had been for 5 years in the 2.3 to 2.9 range. I elected the 5 proton radiation treatments because I am 74. If it comes back in 15 years that makes me 89. I don't want to die in a nursing home.