I need advice to help make a decision.......

The recent seminar I went to shows that intraductal is aggressive and usually means you have cribriform. Because of that doing something makes more sense.

I wish you had mentioned what your Gleason score is. And also a decipher score if you have one. The Gleason score tells you how aggressive it is. If it’s above seven then you are aggressive along with the intraductal aggressiveness is even a little higher. This disclosure about intraductal being so aggressive is sort of new news. I will be posting a link to the video of that meeting when it becomes available.

Yes, you could wait until your PSA hits .2 to do the salvage radiation. As they said the results are the same. With other issues, metastasis could appear while you’re waiting, but at .2 there won’t be a lot.

I’ve been on ADT for eight years. In my case, I don’t get the fatigue. I do get the hot flashes and brain fog and loss of muscle. Going to the gym three days a week now to try and rebuild my muscles. If you start weight training when you begin ADT, you may not lose too much muscle. I am 77 and not overweight, I keep a very tight lid on my weight. Some people gain weight with ADT, you don’t have to.

I would avoid ADT as long as you can. In my case, I had radiation3.5 years after surgery and was not put on ADT until my PSA started rising again 2 1/2 years later. They didn’t know I have BRCA2 15 years ago when I was diagnosed, just found out two years ago,. My PSA was 4+3 so not too aggressive, that didn’t stop PC from coming back four times.

Wish you luck.

@chipe If you decide to do radiation and a real time built in mri machine is available (Mridian, Elekta...) you might want to consider that. If 5 hypo fractional treatments are available, maybe that can apply to you. How much healthy tissue is exposed to radiation, matters.

With the PSA being about 57% accurate, you may want to consider the PSE blood test which raises accuracy to 94%. They do the test for new and biological re-occurrence. You can email the VP of clinical diagnostics at oxford biodynamics. They make the test and he welcomes questions: joe.abdo@oxfordbiodynamics.com.

You want to do a PSE test to prove that you actually have prostate cancer if you are on active surveillance? He’s already had a biopsy, which shows he has it. Do you really think a PSE test will be useful in this case?

You want to do a PSE test to prove that you actually have prostate cancer if you are on active surveillance? He’s already had a biopsy, which shows he has it. Do you really think a PSE test will be useful in this case?

The company rep told someone on the board that this test is useful even after prostate removal. If healthy tissue is left behind (nerve sparing) and PSA starts to rise, this PSE test can accurately (supposedly!) determine if the rise is from cancerous or healthy cells.
Would be a game changer IF that were true!

They are still seems to be an open item question as to whether or not he has cancer and maybe that will help lean him in One Direction or another

All this discussion about Cancer or NO Cancer .
Consider my two Transperineal MRI Fusion biopsy results . And 2nd and 3rd opinions on my 2nd biopsy results .
Biopsy # 1 5 cores in the target area -- ALL NEGATIVE .
Biopsy # 2 16 cores -- 6 in the target area . ALL 6 Cores in the target area Gleason 6 .
2nd Opinion ---------------------------------------- " " " " " " " Gleason 7 (3 + 4 )
3rd Opinion ---------------------------------------- 4 Cores G6 2 Cores G7 3 + 4
Four opinions -- take your pick -- DO I HAVE CANCER ?
I predict that AI will take the interpretation out of the hands of the pathologist . As they say : " Beauty is in the eye of the beholder ". It was suggested I get another 4th opinion -- I suspect I would then have five different interpretatioons .

I'd modify the prediction to say that AI will automate a lot of the pathologist's work. The problem is that AI has no "common sense" — it just matches patterns in ways we can't really audit or explain, and every once in a while the match it chooses is absolutely bizarre. So while AI can uncover new patterns for a pathologist look at, in the end we'll still need the pathologist to decide which are meaningful and which are nonsense.

I'd modify the prediction to say that AI will automate a lot of the pathologist's work. The problem is that AI has no "common sense" — it just matches patterns in ways we can't really audit or explain, and every once in a while the match it chooses is absolutely bizarre. So while AI can uncover new patterns for a pathologist look at, in the end we'll still need the pathologist to decide which are meaningful and which are nonsense.