Just diagnosed gobsmacked looking for advice

You certainly have a lot to consider. Like most people, making this decision is not easy and it usually boils down to the side effects, which there are many.

Side effects of the surgery and side effects of the cancer.

I elected surgery because it provided the best alternative if the cancer returned which it did. By having the PSMA Pet Scan, we were able to catch it before it got too far. I don't like the side effects of the surgery or the treatments, but I am pretty sure they are better than the side effects of the cancer and I would do it again.

Your cancer is aggressive with that kind of PSA increase. Mine was fast growing also. One thing I did to help me make the decision was to get the opinion of an oncologist who does neither radiation nor surgery. That too was helpful.
I hope this helps. Lastly, I would pray for wisdom.

All the best, John.

Yep, sounds like how I felt when I was diagnosed 3/30. My best piece of advice is go to a recognized "cancer center of excellence" if that's an option available to you. Google it and you'll easily find one. I did (Mayo Phoenix) and I was very happy I did. I felt the advice and care was outstanding. Also, I'd recommend Dr. Patrick Walsh's Guide to Surviving Prostate Cancer Paperback – October 3, 2023. It's on Amazon and it's the best $20 I ever spent. It really helped educate me on some key points in my decision making. In the end I felt surgery was the best option for me and that's what I did on 6/24 at Mayo Phoenix. So far the results have exceeded my expectations.

I'm glad you found this forum. It's a tough emotional rollercoaster. I got my Gleason 3+4 diagnosis at age 53 this February. Apparently, it's an aggressive variety. I'm choosing surgery, but I've gone back and forth a half dozen times. (Ultimately, I decided based on my age that surgery is my best chance longer term.) I've read at least 9 books since my diagnosis just trying to get my head around this. You'll find out how many others have prostate cancer when you realize that most of the books in the library have a waiting list. Amazon will have a ton. A few are: (1) Dr. Walsh's guide to surviving prostate cancer, (2) Invasion of the prostate snatchers (I know, silly name but decent book), (3) You Can Beat Prostate Cancer (this one really sells proton therapy) and several diet books about attacking cancer with food - (1) The China Study, (2) Anti Cancer, A new way of Life, (3) Cancer free with Food.). The food books are interesting for longer term, but they don't answer the immediate question of what you should do. For that matter, none of the books answer that question, but they each have a nugget or two that helped guide my decision. I got a notebook and started outlining questions to ask various providers so I didn't miss anything. That helped. I believe that the advice in this forum to take some time to figure out the best decision for you is good advice. Good luck!

Hi Friends, just wanted to post with my promised update.
Last month I came to this board with help trying to decide between surgery and radiation. I received so many wonderful replies that I was frankly overwhelmed that so many of you took the time to respond in such an informative and compassionate way.
And well now the decision is made, but was made by circumstances I did not anticipate. PMSA PET Scan revealed a three centimeter spot in the bone on my left arm that a subsequent biopsy confirmed was prostate cancer. So I have new diagnosis of oligometastatic prostate cancer and am now Stage 4, not Stage 3.
According my medical oncologist (and the radiation oncologist agrees) we will follow the statndard of care for this type of prostate cancer which is radiation plus 24 months of ADT. Not the answer I hoped for but no debate about surgery now. First shot is tomorrow. Am glad to be under treatment but know what I am looking at is pretty daunting. .
I will try and be as helpful as I walk throughy my journey as you all have been to me. Thanks again to you all.

I had a similar diagnosis, except that the metastasis was very large and on my spine. It's eminently treatable these days.

Have you and your care team discussed adding an ARSI like Erleada to boost effectiveness of the ADT? And are they going to radiate both your prostate and the metastasis?

Best of luck, and keep us informed. I'm almost 3 years into stage 4 oligometastatic, and while the side-effects from the treatments are very real (and especially challenging in the first months), in other ways I feel stronger and healthier than I have in years. I hope the same for you.

So she told me she will be administering an Eligard injection every three months and I will be taking Zytiga (abiraterone) and a low dose of prednisone daily. I meet with the radiation oncologist again next Monday to firm up the radiation schedule but yes he plans to radiate the prostate first and then the spot on the arm.
Very encouraging to hear what you say about feeling stronger and healthier. I know the side effects can vary by person, and in some cases be brutal, but I am trying get my diet and exercise program ramped up to meet the challenge. I also keep telling myself to remain positive that at least I have a plan for treatment and we just need to work the plan now and all the anxiety about which treatment to pursue is in the past.
Thanks for your encouraging reply.

I'm heading into a prostate biopsy in two weeks. My oncologist said that at 77 he didn't think he would remove the prostate and that the MRI showed the cancer 'enclosed.' My thought is that the biopsy may lead him to a different conclusion? Also, what kind of radiation are you using mhread? I tried to bring up proton treatment but the oncologist wasn't interested in talking about treatment until after the biopsy results are returned. If I do proton, I'm looking at Orlando, FL, as closer to me in St Pete/Tampa but Jacksonville is also possible. But I get ahead of myself. Best.

Hi @kmat, sorry you find yourself in this spot. My radiation oncologist will use IMRT on my prostate and SABR on the spot on my arm. Both my radiation oncologist and my medical oncologist (and they work at two different facilities) said I was not a good candidate for proton or SABR radiation to the prostate,
Good Luck to you.

I *think* that both the pro and con of IMRT is that it affects a larger area than SBRT or Proton — is that right?

It would be a con if you wanted to minimise collateral damage in the pelvic area, but a pro if there was concern that there might already be some local spread (if I understand correctly).

I did 39 sessions of IMRT followed by ADT. I am just finishing 24 mos of Lupron (eligard), Zytiga, Prednisone.
It is a bit brutal (age 76). The last few mos have been better .
I found myself not giving into fatique and powering through to do the things I enjoy in my shop. I started by picking one activity then accomplish it and resting. Now I'm trying to be active from 7:30 until 11: 30, eat a light lunch, take the prednisone and try to nap. It seems to work on most days. Prednisone is a real batch.
GOOD LUCK TO ALL OF US.