What should I do for treatment plan?

ADT=Androgen Deprivation Therapy. Most Prostate Cancer (PC) stops or slows spread when deprived of testosterone and other androgens. PC that does not is called "castration-resistant." Today most "castration" is done chemically with shots or pills, i.e., ADT.

Not convinced that experienced people always offer the best advice. Almost to a man, we recommend the route we took to others. Only time will tell which is the best option for those diagnosed in 2024.

Do as much research as you can and base your choice on what matters to you.

That will be the right choice. Good luck.

@chunghk1 you might want to include the MRIdian and the Elekta Unity radiation machines in your research of treatment machines. They have a built in mri so the margins, the area outside your prostate that gets exposed to radiation, is much less, 2 mm for the MRIdian vs 3-5 mm for most other types of non mri radiation machines (see the mirage study). I had 5 hypo fractional treatments ending in February of 2023, 3+4 Gleason, 10.2 psa and no ADT.

Chung - you have this ! Dont worry too much . Your G-8 is a slight concern , rather aggressive cells , BUT these days they have plenty to battle it with . Whats your age and PSA ? What does your PSA profile look like and intervals ? I gather yoru in the USA , or ? Going right to a PSMA-PET , is more American than some other countries - you have a ton of them down there ! Learn as much as you can. I would say your Dr is doing the right thing by getting the PSMA-Pet right now to see what you up against ...then treatment options like Radiation and Operation. Many different type of both silo's . With the operation you get the prostate to biopsy - this can be crucial . I found that the nerve sparing operation is very good , but takes longer to recover. Talk to at least 2-3 urologists before you make a decision would be my advise too ! Also even a Radiation Oncologist . Each 'thinks' their method is best , however each have positives and negatives . Outcomes in 2024 is , in balance, very close to each other. God Bless and let us know about yoru decisions and progress . You will be fine . Be positive as possible and do lots of research and get a binder now for all images and lab work , and make notes after each Dr. meeting. YOU must create your own file . James on Vancouver Island.

@chunghk1
I think your urologist is doing the right thing. A PSMA is a good test to help rule out the cancer has not spread outside the prostate.

You will have many options in what YOU decide for your treatment. It has to be what you decide is best for you!
I would research cites like Mayo and Cleveland Clinic as well as other outstanding clinics and institutions that offer the latest in prostate cancer treatments.

I also suggest getting second opinions and asked every question you can think of or that others advice you should asked.

Even in the last 2 years (I had my treatmetns 1.5 years ago) I see many many new mentions of new radiation and surgery type treatments that I did not see when I was diagnosed in January of 2023.

I see that Vancoverislandhiker is again giving you excellent information and suggestions. He had surgery, I had radiation only. Do your research, talk to your doctors, get second opinions. Talk to your doctors about Decipher tests, PSMA which are all good tests to give you more information of the risk level of YOUR cancer as well as helping determine if cancer is still within prosate or has spread outside.

Even when PSMA don't reveal this most R/O will do the margins outside the prostate to just be cautious. Surgery removes the entire prostate but need to make sure cancer has not spread outside prostate. I have read but was not knowledgeable of some surgeries where entire prostate is not removed but a more precise surgery to the known areas. The only comment I have on that is you are dealing in most cases with cancer at celluar level and finding all of it is very hard and difficult.

Even though I had MRIs/fusion biopsies that showed cancer my R/O stated was going to treat entire prostrate with radiation not just the areas found on biopsies as again dealing with cancer at cellular level not just tumors.

I read your post and am very unclear about your gleason score. You need to discover this.
Also this information i post below… show it to a friend that is very good in mathematics so they might understand.

https://www.prostatecancerfree.org/compare-prostate-cancer-treatments/
Here is a good website to compare odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see the odds of 10-20 yr survival, etc. based on the treatment you pick.

It is best viewed on computer or just print it on paper. Not so viewable on phone.

To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.

Also be aware the the graphs don’t show any salvage radiation benefit. This would boost the surgery odds up a bit.

And, this is a very dysfunctional industry from my view. Loads of bad info mixed in with the good info. Same with the docs. Some of them are more dangerous than the cancer.

@chunghk1, after gathering information about the specifics of your diagnosis, talking with your cancer team and reading the experiences of the criteria other men used to make their treatment choices, what treatment options dd you and your cancer team decide is best for you? When do you start treatment?

Got any more questions as you prepare for treatment?