Prostate Cancer (47 yrs old) - Guidance Request

Get the Dr Walsh book, read the “highlights” at start of each chapter then read the entire chapter to learn more when it is pertinent.

Get a PSMA scan to see if the PC is confined to the prostate or has spread.

IF, IF you choose RALP, do several weeks of Pelvic Floor PT with a DPT trained in this; and a few more weeks after the surgery. (I, at age 72, opted for RALP, did this PT regimen and was 100% continent. )

Sorry you joined out “club” but there is lots of advice available here.

Best o luck!

I would also recommend Dr. Walsh’s book - I believe the name is Guide to Surviving Prostate Cancer. One thing my doctor mentioned of deciding between radiation and RALF was if you have radiation treatment, then that usually preclude you being able to have surgery later. I have not verified that from another source though.

There's no question that radiation scars the tissues which it hits. That scarring ("adhesions") makes the tissues more like hard gristle than soft fat or muscle. As a former surgeon, I would dread operating on someone with previous radiation. There many urologists who defer such cases to others who are more willing to take on the arduous task.

The radiation oncologist with whom I consulted said the same. I didn't like that idea nor the prospect of months of daily trips to the hospital for radiation. I opted for RALP. Once and Done, so it seems.
I also recommend PT - unfortunately my surgery scheduling was rather sudden, and I didn't have the chance to begin PT prior. Several months of PT mostly cured my incontinence. However a year later I still find then need to wear a "Shield". No big deal.

I would do surgery first. If you radiation first surgery is no longer an option. You’re slightly younger than the average person in this group You may want to discuss the sexual performance implications of these various treatments. Get Walsh’s book.

My Mayo doctors told me that they CAN do surgery after radiation. There is also a one (and two)-stop radiation option. My case was similar to yours (3+4) but worse on other stats (5 lesions some at PI-RADS 4; PSA at 5). But I elected to put myself on my own kind of active surveillance (just watching PSA). I lasted a year until my PSA jumped to 10 and a second MRI showed significant growth and pressure on the capsule (tumor trying to get out). Then I had two sessions of HDR Brachytherapy. No pain. No ED. No incontinence. Also no working prostate. But I was 69 at the time so the 20-year possible effects of radiation were not a concern for me. It sounds like, in your case, you might have a serious talk with Mayo doctors about waiting to see if you can hold out until a great new cure comes along.

My husband's Mayo doctors also told him that surgery can be done after radiation treatment, but they also said that many surgeons decline to do it. There are surgeons in Urology at Mayo Rochester who do surgery after radiation.

Welcome, @joeck. You're right. Personal convenience of travel and daily treatments is a contributing factor when choosing treatments that offer similar efficacy.

Do you continue with Kegel exercises? How are you doing now, one year later?

1 year later -
Just got back from visit w urologist. PSA finally down to < 0.008, i.e. non-detect!
I've been on Lupron for a year with many of the common side effects, mostly minimal and better than having cancer. We are now suspending Androgen Deprivation Therapy at least temporarily. We will monitor PSA and re-evaluate need for ADT or other treatment if the level goes back up.
Erectile dysfunction is still 100% (despite various efforts) but hoping that the return of some testosterone will help that.
Urinary incontinence is still minimal. I had suspended Kegel after 6 months but I am going to get back into it. I need assorted exercises anyway though I am a fairly active 73 year old.

jtmarti1: I had 10.2 psa and 3+4 Gleason with low risk Decipher and Prolaris score. 5 treatments on the Mridian in Jan/Feb 2023 with Spaceoar. Looked at all radiation options and DaVinci robotic removal. Healthy tissue exposure and quality of life were KEY to my decision. 2mm margins were used with the Mridian instead of many other radiation machines which use 3-5 mm (margins are how much healthy tissue get exposed). Real time MRI images were also important to me vs fused images. Both issues were HUGE to me. Spoke with 5 RO's, Spaceoar technicians, multiple patients on the phone (including robotic) and the Mridian manufacturer, at the time.

Limited side effects were narrowing of my urine flow after the 3rd treatment which Flomax took care of within 24 hours. No pain or bleeding.

The Mridian is still being used even though Viewray went bankrupt at the end of 2023 and it seems some places have found a way to still use the machine safely. Here is an unconfirmed list of hospitals still using it and I am not sure if it is complete:
UCLA Health Jonsson Comprehensive Cancer Center
UCLA Health
New York-Presbyterian David Koch Center
Henry Ford Health
Baptist Health Miami Cancer Institute
Memorial Sloan Kettering is using the MRI guided Elekta machine