Gleason 6 But high decipher score.

I can always do radiation after prostatectomy, if needed; but I can't do it the other way around. (RALP after radiation is not so good.). Also, I decided against radiation b/c of its propensity to cause more cancer in 20 years. If I were 70 and looking at potential cancer recurrence at 90 (i.e., in 20 yrs), I would take that risk. But at 53, a recurrence of cancer in 20yrs (at 70) is not a risk I wanted to take especially considering that I caught my cancer early and have a decent chance of removing all of it with RALP. Everyone has their own plan. I'm just crossing fingers that mine works for me.

Thanks. What would be my options if do IRMT initially and the cancer came back in 5 or 6 years. I am currently 70 years old with a Gleeson 6 small tumor.

Forgot to mention that I have a high decipher score

That's a great question to ask your doctors and research. It probably also depends on your overall health. There are many treatments (Dr. Walsh's book talks about options in Ch. 5), but my understanding is that a 2nd round of radiation if the 1st fails is not very recommended. Radiation isn't kind to your surrounding parts (bladder, colon). Seeds may be an option if IRMT fails - Research it, outline all the questions you can, and ask a specialist (dr.). I typed out all of my questions and interviewed doctors with them, which I found helpful. Be wary of practitioners trying hard to sell their services a little too hard. I don't think there is usually one "right" answer. You need to find which treatment is the best match for you and your circumstances.

My husband had his surgery at Mayo in Phoenix seven weeks ago. He is doing great! His pathology came back and he was upgraded to a Gleason 9. Lymph nodes were clear and we are so thankful he chose surgery! Best of luck to you!

If IMRT fails and PCa comes back in the same area your options as I understand them would include combination first generation ADT (Lupron, Erleada, or ORGOVYX) and second generation ADT, (Abiraterone or enzalutamide) along with some form of chemotherapy. Depending on the genomic profile of your pathology you might be eligible for something like T cell therapy.

I can’t tell you how much I regret having radiation as my primary therapy in 2020. I wanted to avoid ED and any possibly of incontinence at all costs. Here in 2024 I recognize that the cost was recurrence with Stage 3 PCa with lymph node involvement.

Whatever you choose I hope your outcome is better than mine!

If you have any questions as far as preparations and what to expect after or helpful things we did just reach out!

caryg1955 @caryg1955, at a high level, I would personally opt for surgery to remove the known cancer. I was diagnosed 2 1/2 years ago at 55 years old with Gleason 7 (4/3). Just before my biopsy, I remember talking to my wife and sayin --> If this is cancer, I sure hope it is Gleason 6. I would still do the robotic assisted surgery, but Gleason Score 6 would give me a lot more confidence the cancer was contained to the prostate. In the end, I opted for surgery for many reason, below are several.
First, surgery removes all known cancer, versus relying on imperfect imaging tools to direct treatment. I did not want to manage my PSA at a low level but rather have a more definitive PSA/Undetectable PSA test.
Second, I wanted confirmation of the cancer grade and aggressiveness with a physical pathology. So many men find they have more aggressive or additional cancer when the pathology is performed. Today's scanning tools are incredible, but I just did not want to bet my life on them. Excellent example is the reply in this thread from "themurfs" --> His pathology came back significantly higher, but thankfully the cancer had not spread to the lymph nodes.
Third, I wanted to reserve all future treatment options in case the prostate cancer came back (thankfully, PSA undetectable thus far). From my research and referencing medical professionals, it is very difficult or impossible to have surgery after radiation.

I am very high on surgery based on my research and outcome, but surgery is not for everyone in all situation. You need to assess your personal expectations for life going forward and take into account other comorbidities and age. I was healthy, relatively young for prostate cancer (55), positive, and have an expectations for 30+ additional years of cancer free life to spend with my wife, son, and family/friends. I know you are 70 years old, but this should not automatically push you to radiation. You should assess your physical and mental health and overall life expectations.

I pray all goes well with whatever treatment you decide on!!

Jim

caryg1955 I totally agree with hammer101's post. I followed a very similar thought process when I decided to have the NS RALP at 70 (5 weeks ago) at Mayo Phoenix. The only 2 things I'd add was my research lead me to believe that the results from surgery (assuming done at a cancer center of excellence by highly qualified surgeon which I did): first, the worst day after surgery is usually the day after surgery. Then every day after is generally better than the day before. Emotionally, this aspect of getting the bad news up front appealed to me. Second, if incontinent or ED, there are reasonably effective ways to deal with it and still have some quality of life. By "quality of life", I was focused on day to day things like sleeping well, enjoying food, being able to continue hiking with my wife, stuff like that. Radiation and/or ADT is much more of an unknown for impact on quality of life, especially if "worst case" happens. So far I'm glad I picked surgery; no incontinence and hopeful signs on the ED front. Time will tell. Of course, while I "think" surgery was the best option for me, it was a difficult choice and I wouldn't remotely suggest I know what's best for someone else. Rather, I just wanted to share my thought process.

Thank you