Pause button: What is your medical history regarding diagnosis and current status: PSA level, testing history, Gleason score, PSMA PET scan, rate of increase and general health/comorbidities?

I had surgery at 72. My health was not an obstacle to surgery, I have longevity in my family and have recovered well from prior surgeries (hips) and was willing to risk/deal with side effects.

My father had a biopsy at age 80 in 2000, had 1 positive core (Gleason not known), was offered treatment choices; chose watchful waiting and I never heard about it again. He passed at 95 w/o evidence of cancer.

In general I favor treatment for PCa, but the need for treatment should be clear.

Bobv48, looks like you have received a lot of great advice. For myself, If you are in good health with no other life limiting issues, I am an advocate for addressing the prostate cancer versus letting it grow and potentially metastasize. I was 55 when I was diagnosed with PC (Gleason 4/3), was in excellent physical shape, no other comorbidities, and had an want for 30+ additional years of cancer free life. I did all the research to ensure I picked a center of excellence (Mayo-Rochester), and went with a robotically assisted radical prostatectomy. I am 1.5 years out from surgery and all looks good thus far --> PSA undetectable, fully continent, and erectile function back.

In my opinion, age is a number, and you should make a decision on your personal physical and emotional health. If I were in good shape at the age of 72, I personally would want 20 more years of cancer free life, thus active surveillance or watchfully waiting for the cancer to grow and possibly metastasize would be off the table. However, if I had other comorbidities, this decision would obviously change.

In my opinion, the biggest advantage of surgery is removal of all known cancer and having the ability to perform a post surgery pathology to define margins & evaluate the cancer more thoroughly. Other treatment plans rely on imperfect imaging and biopsies to guide the treatment. I have personal family history (uncle) and read about far too many men who went with a less invasive treatment plan and lived to regret it. For myself, life was my #1-need, with a high want for continence, and a far lower want for erectile function. In the end, the only treatment plan that made sense for my personal situation was the radical prostatectomy at a center of excellence (with the best surgeon I could find). From what I have seen, men that do not utilize a center of excellence are at a far higher risk of incontinence, impotence, or other complications.

As always, the above comments are my personal experiences. Each man has to decide for himself what treatment best fits his wants/needs. In the end, we need to be confident in our treatment decision and live with the consequences.

Good luck on your decision and hope all goes well.

Jim

that is a major surgery I was 68 when first diagnosed with a psa of 12.5 and metastatic because it was metastisized already they did not recomend surgery I had 26 rounds of radiation and 18 months of lupron with aberaterone and seeds placed in my prostate hurt like hell,18 months later I was 0.05 undetectable for another 18 months then started to tickup now on lupron and xtandi going for another pet scan. if I was you go with the radiation 15 minutes a day done.