Gleason7(3+4) - treatment options recommendation

As I wrote, it's a very personal choice.

In my case, with stage 4 PCa, I expect to be on ADT and ARSI "forever" (or until there's a major medical advance), and that probably has a bigger impact on sexual function than either radiation or surgery, so that's a bit of a moot point.

A friend of mine was diagnosed with very early-stage prostate cancer over a decade ago, in his 50s, and insisted on surgery because he'd seen his father die from prostate cancer and just wanted to get rid of the thing, regardless of side-effects. He's had no recurrence (probably wouldn't have with radiation, either).

I think we need to respect that we're all starting from different places and have different priorities.

I'm sure you can provide a link to your peer reviewed research including the 10 year cancer-free and survival rates for RP and RT with data through 2023. Along with associated issues such as urine leakage, ED, bowel issues, blood in stools and fecal leakage. Does your research utilize Odds Ratios using the Mantel-Hoenszel method along with the Z test to assess significance? How about cause specific survival, overall survival, disease free survival and toxicity outcomes? Now please keep in mind that a pragmatic approach to offering advice is preferred by most just as staying on this side of the dirt is a priority.

FWIW, I chose surgery ONLY because if the cancer recurred I could treat it with hormones and radiation - which I am now having done 5 yrs post op. Thank goodness for second chances.
But even my surgeon who has gone on record against radiation as primary treatment told me that if I were 10 yrs older ( 64 at the time) he would recommend Cyberknife. He said that my Gleason 4+3 had a good chance of returning even with his best efforts. He said that he had performed many surgeries after radiation and they were difficult and with many complications.
So I basically agree with all sides here - it just depends on your particular set of circumstances and your personal choice.

I was under the impression that if you have radiation then an RP down the road is totally off the table?

You're 56, that's pretty young for radiation, from what i've been told. My prostate was removed the day before i turned 52, radiation wasnt an option because IF the radiation doesnt work, there are much higher risks for complications if surgery is needed after radiation. Not to mention, radiation in 'younger' people isn't recommended because it can cause issues as we get older. Regarding the urge to pee or leakage... it's almost a certainty that its going to be an issue for a while. When i met with my Mayo team at my 3 month post-op appointment, they asked about continence and leakage - which is almost totally corrected now, as well as ED. I was surprised to learn that most people have the incontinence issue for longer than 3 months. ED, on the other hand, is something i definitely still have an issue with. Best of luck with your decision and recovery!!

That used to be true. It no longer is. Surgery can now be done after radiation.

Aren’t you’re the one that said results of the same weather RP or radiation?

Absolutely not.

I did ask about the same q to the UO. Their response was while it is difficult to perform RALP after radiation , they do perform it on case basis. Same question I asked RO their response was similar to yours. But yes for person like in my age group , in general RALP is first preferred option (per UO). Proton treatment in my case is not preferred because (a) there has been significant advancement on photon tech and precision is in micron level and (b) proton is offered with Medicare

Have you all read the findings of the U.K. Protec T Trial ?
Also , I continue to be amazed at the MAJORITY of prostate cancer patients , a deadly disease , who set as their # 1 concern : ' Their potential loss of an erection " . Something else is missing in their life .