Deciding between radiation and prostatectomy

Yes, I understand what you mean. We have the same problem in my professional field (I don't want to be too specific, because it might make it easy to identify me). There's a big push for "data-driven decision making", but data alone gives a false sense of confidence that you're taking a factual/neutral approach, when it's really just a very-low-resolution, pixelated snapshot of a complex, messy reality.

These days, there's a big push to combine quantitative and qualitative data (including feedback from the people we're supposed to be serving and the experience of practitioners) to get a better-rounded picture of what's happening and where we can fit in. The data still matters a lot — especially for things like drug trials — but it's just the start of the journey, not the end.

Outstanding comment!

Great comment ! Statistics can be tricky ! I was diagnosed with my PC with a PSAof 4 , and Gleason of 3+4 =7 when in 2021 at 57 . Relatively young , but I had it in the family too ! Man I use to go for general physicals every year and would check out my check-up through a Urologist ever year too just to be on the safe side . Well 5 years after I was going to Urologist post physical , I got the diagnosis as well. Operation then followed with EBRT ( 22 sessions) a year later . PSA now is 0.052 and defending slightly each 4 months when I get my PSA tests . I still have anxiety about the PSA and PC in general ! God Bless Sir ....

Million dollar question. No real right answer per se . With the operation you will likely have to get EBRT at some point as well ( but that is not a huge deal, per se ) . If you go for the operation you will get the Biopsy - huge deal as then you get to see the margins, size, shape, lessons and other factors . With radiation you cannot get the 'whole' biopsy . Operations after radiation is not usually an option - but talk to many doctors before you make a decision. Ask why ...they are deciding one way versus another . God Bless Sir !

@beluga
I am just diagnosed Gleason 3+4, Decipher score .46.
Thank you for your thoughtful input.

I was just diagnosed with Gleason 3+3. .07 lesion contained in the gland. I spoke with the radiologist/oncologist at Mayo. He went through each option. I chose active surveillance and would Jean toward radiation treatment if/ when needed, I am 79 yrs old.

@rtorretti Your numbers are similar to mine (see notes in my profile); 79 yrs old, otherwise good health. I chose AS a year ago and the 2nd MRI/biopsy numbers last month show 3+4 and 4+3 in three of the needles. PSA (7.67) is still in the normal range for a prostate as large as mine (114cc). I'm now looking at treatment options and leaning toward TULSA-PRO if my PMSA-PET doesn't signal anything that would discourage that treatment approach. Hang in there!

My biopsy came back with two cores, one at 3+4. I decided on removal. I had ZERO incontinence. However, My post op pathology report came back that the cancer was 4+5. The last 2 1/2 years , my PSA has been < 0.01. Of course, I’m glad I had it removed. Some food for thought for you. Best of luck on your decision!

@ray092271
That is a somewhat risky situation. The question is how many 3+4 cores Were found in your biopsy. What percentage of four was found in those cores? If it’s very low percentage, and there was only one or two, then you might be able to go on active surveillance.

Were any of these things found in the biopsy intraductal, cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

Your decipher score does show a moderate amount of risk of reoccurrence. As a result, you probably want to Have treatment. Have you had a PSMA PET scan to see if there is spread anywhere else in your body? That is really important to have done before you continue with surgery or radiation. That can make the decision on whether or not radiation is the answer.

@rtorretti
How many 3+3 cores were found? If less than six, then active surveillance makes the most sense. Many doctors do not consider 3+3 to be cancer. Over treatment of 3+3 is a real mistake.

You could get a PSE test to see if there’s actually cancer in your body. That test is 94% accurate. The biopsy can only access one percent of your prostate, as a result you could have much higher Gleason scores in the prostate itself, but you don’t know until it’s removed Or you get another biopsy.

Did you have an MRI before the biopsy was done? That way, they know where to get cores in the biopsy, If the MRI shows that there are tumors found.