46 year old, two lesions. Pirad4 Pirad3

I'm sorry for your news. I was diagnosed with stage 4 PCa at age 56, not quite so young, but still young. It's a shock.

Where are your lesions — remote (e.g. on the spine), or near/on the prostate itself?

For remote lesions, it seems it's most common to do radiation rather than a prostatectomy, since the horse has already escaped the barn (so to speak).

For early-stage PCa, studies have shown similar overall survival for radiation therapy and prostatectomy (but note that the prostatectomy may also require "salvage radiation" afterwards if there's concern about spread).

Many people here in the forum have strong opinions one way or another, but in the end it really comes down to advice from your medical team and your personal preference. Both treatments can have side-effects that last months or years (or forever), so look into those and decide which you're more willing to live with.

Best wishes!

Thank you, the MRI doctor told me that it’s still confined within the prostate.

It’s been nerve racking and I’m having some mental issues with all of this and also having some other family problems ONTOP of this issue. So it’s like I’m juggling numerous issues at the same time. Thank you.

I'm sorry to have to welcome you to this unlucky club. 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 strongly 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. It's organized in a way that makes it pretty easy to drill down on things applicable to your specific situation. One other thought I'd like to share is that for me (I'm 70 and was diagnosed on 3/30/2024) the more you educate yourself the better you'll be able to discuss treatment with prospective providers and the better you'll be able to make the decisions you'll have to make. It's like drinking from a firehose at first, but it's worth the effort to get knowledgeable as quickly as possible. I guess one thing that surprised me was I'd never really been seriously sick before, so I didn't appreciate that I'd have to ultimately select my course of treatment. Yeah, you'll get recommendations, but the final decision on how you proceed will ultimately come back to you. So it's pretty important to understand your options at each step as thoroughly as possible, especially since selecting an option might eliminate or impact other options going forward. Best wishes to you and yours.

Yes, wouldn't it be wonderful if life gave us just one crisis at a time, instead of piling them all on?

It sounds like what you need is time. Ask your oncologist(s) how long it's safe to wait before deciding between radiation or surgery. Even just a few weeks could give you the breather you need to get used to the idea of having prostate cancer.

Others have recommended Dr. Walsh's book:
https://www.amazon.com/Patrick-Walshs-Surviving-Prostate-Cancer-dp-1538726866/dp/1538726866/
I read it, and while nothing's perfect, I think it's a good, compassionate overview of the different treatment options available circa 2022 (when he would have been submitting his final draft before proofs for the 2023 publication). Most of it was stuff I'd already learned from my medical team, here in the forum, and elsewhere, but it's useful having it all in one place, and it will help you make a list of questions to ask your own medical team.

If you buy it, make sure you get the 2023 edition (the 2012 edition would be seriously out of date).

Was just talking with somebody who is 50 and found out they have a Gleason score of 4+3 and that has spread into their seminal vesicles and other surrounding prostate tissue. Since his is all centered in the prostate surgery is what actually has been recommended. Radiation is an option, but With the fact that it has spread To other tissue around the prostate, surgery may makes more sense. This is where you want to speak to a radiation oncologist, probably more than one, to find out what they think

In your case, where are the lesions? If they are right around the prostate, then surgery might make sense. The other option is to have radiation or surgery to the prostate and then use SBRT (cyberknife) to treat lesions. In that case, you want to talk to radiation oncologists, surgeons who do prostatectomies and a Genito urinary oncologist to help you navigate all these options.

A major question is, what is your Gleason score? You should find that out pretty soon since you had a biopsy.

MRI apparently shows two lesions contained, no spread outside, Biopsy is october 3rd, but all factors considering im getting mentally ready for some not too good news. If possible, I’m leaning toward Brachytherapy. I guess I would have to speak to my doctors regarding options.

@intriagozz Consider asking your doctor who does the biopsy to submit your biopsy material for the Decipher test. It IS USED by doctors and has changed treatment decisions by doctors. It gives them, and you, a feel for aggressiveness and modes of treatment.

I decided on radiation with a specific radiation machine (the mridian) that has a built in MRI so the exposure of healthy tissue was less vs radiation with other machines that used fused images only and that, can expose more healthy tissue potentially impacting side effects. Fused images and their associated radiation machines, instead of real time image radiation treatment, usually require larger margins of radiation exposure around the prostate. With the Mridian or the Elekta, essentially what you see is what you treat. You can Google the Mirage randomized trial study that shows the impact of radiation machines with built in MRI vs those radiation machines that do not have it.

If you get radiation, you may want to consider a spacer gel i.e. spaceoar, bioprotect or biogel, to move your rectum further away from your prostate and reduce radiation exposure.

Having said that, you will read about all sorts of success stories with both radiation and prostate removal on this web site.

I haven’t had my Biopsy yet, but preparing for the news, I was wondering which treatment could be better for a 47 year old male.Brachytherapy, HIUFU or total removal. Pirad4- right posterolateral peripheral zone mid gland// Pirad3…Right anterior lateral peripheral zone at left in the mid gland apex.

The results of your biopsy will give you more information about what option you should take than anything else?

It’s therefore too early to plan. Radiation and brachy are popular. If all cores come back above 6 then maybe surgery. Work with a urologist and a radiation oncologist once you find out your biopsy results.