Gleason7(3+4) - treatment options recommendation

Very nice description of your life in beautiful Victoria!

Regarding: " but most have a trace after surgery , you are right . "

Last week my surgeon explained why my first post-surgery PSA of 0.009 was not "undetectable" as I thought. He said that when the surgeon separates the prostate tissue from the bladder neck, the prostate tissue is "torn away" from the bladder neck and some of the BENIGN prostate cells remain behind on the bladder neck. (In my case, the cancer was not near the bladder neck) These benign cells naturally generate a small trace of PSA. My next PSA test will be in three months and if that PSA remains at or near 0.009 that will be my unique baseline against which future bi-annual PSA tests which be compared.
But if my PSA level has risen significantly higher than the 0.009, that would indicate that prostate cancer cells remain somewhere in my body and further diagnostics and treatments would be considered.
His explanation made such perfect sense, I thought I'd share it with the brethren.
Best of luck on your journey(s).

So you are kidding yourself with a false PSA number ? How does this help in the long run ?
You may as well kid yourselff that you don't have prostate cancer .

@pmclarksr -- I saw your question to @heavyphil and thought I'd weigh in as well since I had bilateral NS RALP at Mayo Phoenix in late 06/2024. I'm 70, 5'11" 187 lbs reasonably fit (not excessively so). Recovery from surgery has been excellent. The week of the catheter was unpleasant, but pretty much as described.
Pain after surgery never exceeded 2 on a scale of 10, although I strictly followed surgeons advice to take OTC pain meds (Tylenol and ibuprophen). Once the catheter came out I had Depends and pads ready, but never had any incontinence except a few accidents as things do feel different. I stopped using the Depends after a day or two, and stopped bothering with pads by about day 4 post catheter. I do still sleep with a pad under the sheet, but haven't had 1 accident during sleep. As I said things do feel a bit different, but every week I feel more confident. No leakage lifting weights at the gym, but if I try to fart I will have some leakage (which I attribute to relaxing the muscles to fart basicly allows the leakage). I did do kegals about a month before surgery and resumed them after surgery when allowed. I have no idea if they helped, although I would guess they probably did. Now on to sexual function. I don't have normal sexual function, and I think that'll take longer to recover (if it does). I am taking Viagra nightly as part of penile rehab to help blood flow. I started trying to have intercourse about 4 weeks after the catheter came out. When I try to have intercourse, I do get a response but it's far from satisfactory. I have seen improvement, but it's too early to know how much sexual function I'll recover. At this point I'm getting maybe 65% firmness (as compared to before surgery) and just barely adequate to allow penetration. My wife is very supportive and patient with me, and a major factor in the limited success I've had so far. I have had 3 climaxes during intercourse, and of course they're dry climaxes and frankly less satisfying than before surgery. But I'm encouraged I was able to climax at all. To be fair, before surgery I had needed Viagra so I wasn't starting from a pristine state. Progress is slow but so far I am still making progress. If I don't recover my sexual function to a satisfactory level, then there's a range of treatments I've yet to explore. As far as everything else (appetite, sleeping, general feeling of health), overall I feel great; just like before surgery. My wife and I are hikers and spend a lot of time together, and other than my reduced sexual performance, we can still enjoy ALL our other activities. For me this has been a big plus. On a positive note, without the prostate my urine flow is great; like I'm 20 years younger. After surgery, the pathology report on the prostate found both Cribiform and IDC in the prostate, which is bad. When I read that I was pretty happy I had the surgery . The margins were clean and indications are they got it all, but time will tell. At this point (almost 9 weeks), I'm pretty happy with my decision to have the surgery but again, time will tell. Of course, every case is different and everybody responds differently to treatments, so I have no idea what's best for anyone else. I wish you all the best in figuring out how you should proceed. If there's anything I didn't cover that you'd like more information about, just ask. I have no reservations sharing anything about my experience.

@pmclarksr -- Thank you taking the time to make me aware of Trimix. I really appreciate your comment. I have read up on it (thanks to this blog) and I intend to try it when and if the time comes. Since I'm so soon out of surgery and based on my reading, here's my tentative "plan". 1st -- at my 3 month visit with the surgeon I'll ask which of the urologists at Mayo Phoenix are proficient in penile rehab and schedule a consult to baseline my progress and get his advice on when I should proceed beyond the Viagra (which I was already using before the surgery). I don't know what's a reasonable time to wait, but I'm sure he will. 2nd -- I intend to follow his advice, but what I want to discuss with him is what he thinks about the following: once I've waited long enough and if the Viagra isn't providing a satisfactory experience, then I'd like to progress through trying the other "pills", such as Cialis and Levitra and Stendra to see if one of them works better (for me) than Viagra. If they all fail as well, then next up on my list to discuss with the doctor is the Trimix topical cream. Then after that maybe the Trimix gel or pellet. I'd like to get to the needle only if the other approaches don't work first. It's early enough I'm still hoping I'll get a satisfactory response from Viagra once I've recovered more. Of course, this is what I came up with based on my reading. Since I'm not a medical professional nor have any experience in this, I really plan to rely on the advice from whoever is the penile rehabilitation expert at Mayo Phoenix. In a nutshell, that's my "plan". Let me know if you think I'm missing something or just thinking about it wrong. Again, thanks again for making sure I was aware of Trimix. I really do appreciate it.

Great info but what does NS RALP stand for? I have not seen that acronym, or if I have I am not connecting. I assume NS stands for non-surgical..

So you are kidding yourself with a false PSA number ? How does this help in the long run ?
You may as well kid yourselff that you don't have prostate cancer .

I am going through the same journey with doctors in Boston. I will be 69 years old in a month, and have: GS 4+3 in 2 cores (left and lateral 8%, right target 25%) - GS 3+3 in 2 cores (left and medial 30%, left posterior lateral 30%), PSA 6.73 — Intermediate undesirable cancer. Options are surgery or radiation with 6 months of hormone treatments.

Have meet with doctors from Dana Farber Cancer Center and Mass General. Over and over I have been told either course of treatment will work with a 98% cure rate, but both have different side effects. Dana Farber has had a very good track record with Image Guided Radiation Therapy, and much lower side effects than the national average.

One has to make a choice as to which side effects you can or can't deal with. After weeks of research, I have found that side effects from radiation can be long term, and side effects from surgery are immediate, and most often they resolve in 3-6 months, sometimes it might take up to a year for complete urine control. At first I was leaning toward radiation, but now I am leaning towards surgery. I have had a PSMA test that showed only cancer in the prostate. Right now I will be asking about a Decipher test. A surgeon I spoke with yesterday once again said either treatment would work for me and spelled out the data on surgery. Last week I also met with my urologist that I have been seeing for eight years, and he recommended surgery, he said it was "predictable" and could not say the same for radiation. I have recorded every appointment with every specialist on my phone and I have been listening to the recordings now that about 7 weeks have passed since my biopsy. You would be surprised about the details you missed during an in person visit or a Zoom call. (My doctor said surgery cannot be done right away after a biopsy, as the prostate is inflamed from the procedure...at least 6-8 weeks are needed before taking next steps, and I was told not to rush, but to feel comfortable with the treatment choice). Good luck in your journey.