Gleason7(3+4) - treatment options recommendation

A young person should not consider a prostatectomy, unless there are a number of mitigating issues. Radiation these days works great for most people who have prostate cancer if it has not spread.

Most people who have surgery have erection issues. Many have problems with incontinence.

You make it seem like surgery is so simple and it’s just the opposite.

People who have radiation seldom have erection issues, just the opposite of surgery. I know more than one person that had nerve sparing surgery and were still unable to get an erection. One guy I know who was an obstetrician, traveled across country to go to a highly regarded nerve sparing specialist only to find he couldn’t get an erection after surgery.

People who have radiation seldom have incontinence problems, at least not until many years after the radiation.

Also get a second opinion of the biopsy as I originally was scored 3+4 with second opinion at Hopkins rescoring it to 3+3. My second targeted biopsy (mri/ultrasound) came up with 3+3 with two benign lesions. I am on active surveillance. Also look into proton radiation

I tried to register for the study (and the spit tube), but the online form says the doctor's contact information is required. It won't let me go any farther until I provide this. Is there any way around this? If not, should I contact the doctor FIRST before I submit this? Thanks!

This is because you checked a box that said you want your doctor involved. Take a look at the options again and you’ll see what I’m talking about. People do not have to have their doctor involved, it’s just a choice

DIG DEEP into the the alternatives to RP with a laser focus on long term percentages around the cancer recurring. I was a Gleason 7(3+4) in July of '21 and took 4 months to make a well reasoned decision. After reading every research paper I could find on the various options, my decision pointed to RP as offering the highest likelihood of remaining on this side of the dirt. To each his own and best of luck to you!

I guess you’re smarter than the doctors then.

No. You are just not aware of how successful radiation has been in the last few years. Many doctors are not doing prostatectomys and instead are suggesting radiation for their clients. Sure if you only go to urologist, they will suggest surgery because that’s what they do but radiation oncologist are the other people that anybody with prostate cancer should consult with.

Surgery is only best in a small number of cases.

Radiation and surgery have similar outcomes for overall survival, and both have progressed to become much less invasive (reducing collateral damage), so most of the time it comes down to personal preference — which set of potential side-effects bothers you less?

Exceptions:

If you're elderly, have co-morbidities that make surgery risky, or already have advanced-stage cancer (i.e. it's spread to other parts of your body), then radiation probably makes more sense.

If you've already had radiation to the pelvic area for a different cancer, then external-beam radiation might not be allowed.

As always, layperson writing here.

As @northoftheborder points out, radiation and surgery have similar statistical outcomes for overall survival. The nuanced, factual and well-documented statistical outcomes are readily available online should one dig deep for those numbers. My RP decision came down to pursuing the best outcome for my specific situation and I was fortunate enough to be in a position to travel to see some of the best radiation, focal-therapy and RP docs in the country before I made my decision. NOW I suspect you have not performed the quantifiable research I have because had you done so you would likely present a more balanced, pragmatic post for those coming here for a laymen's perspective. Now as for the erection issue you are laser focused on, that was a secondary factor for me on the decision tree, but even with one lost one nerve bundle I still achieve the "elusive erection" as needed. Yes it took some work post-surgery but with effort and a few months of Trimix I have zero issues in this area.

Well, you make the case for me. Statistical outcomes the same.

With surgery because of the reconnection of the urethra without the prostate in the way result in a shorter penis.

With surgery, majority of people are unable to get an erection without a lot of help.

With radiation neither of those problems occur for most people.

If Statistical outcomes are the same. What would you prefer to happen to your body?

As for finding out what’s going on with a different procedures. I’ve attended the Ancan.com advanced prostate cancer meetings every week for about five years. We constantly have people come in that are either getting surgery or radiation, many different types of radiation. There are always around 35 people showing up at every meeting and many of them have questions about issues with their procedures. People are encouraged to get radiation if it at all makes sense.

I also attend another 2 hour group meeting that meets twice a month and the third one at UCSF that meets once a month. I hear about the results from many people about what’s going on with their prostate cancer.

I keep up with a lot.

I also help people as part of Immerman Angels. They assigned people to me who have similar prostate cancer problems and want to talk with somebody who has knowledge and experience.