Sway

I would normally say with a Gleason 6 you don’t do anything, but the PNI means that the cancer has spread outside the prostate. Even though Gleason six, isn’t really considered cancer by many doctors, yours has pretty much proven itself to be cancer.

It could be that your Gleason score is higher, but they’re just not getting biopsy samples from the right area. My Gleason score was 3+4 before surgery and 4+3 after. I know people that have gone from 3+4 to 9 after surgery, So it’s hard to rely on the Biopsy all the time.

Both choices you have outlined would probably work quite well, But I suspect that if you have surgery, they would want to do IMRT radiation, since it’s already spread outside the prostate.

Are you being treated at a center of excellence? Getting opinions From more than one Radiation oncologist And urologist, Asking about the need for radiation after surgery, could give you more information about what direction to choose.

@packman7
We all were at some point in our journey of what to do.

Asked your urologist about getting a Decipher test. The Gleason 6 is low and usually I see others who are at 6 getting active surveillance. I was 3+4=7.

Do some research on proton and photo radiation if your urologist and R/O are recommending treatments. You say other issues are present justifying treatment versus Gleason score of 6.

This is why your medical professional know you and your case and your specific medical profile.

Mayo Clinic, John Hopkins, Cleveland Clinic are great sources of treatments along with the proton radiation you mentioned.

Also if you have the time you can request a information package from UFHPTI. They are proton radiation providers since 2006. The packet they send has the two books on prostate cancer you see mentioned here on MCC. The include information and research on prostate cancer, the treatments, the outcomes, the side affects, and also what UFHPTI offerrs. It a free package (FED EX to you) with a ton of information and abosultely no pressure to go to UFHPTI for treatments.

What did I have. Rising PSA numbers but still normal. Referral to urologist for DME, normal. MRI done as MRI/Fusion showing suspicious areas. Biospies scheduled. Came back 3+4=7. Referred to R/O. R/O recommended photon radiation with hormone but ordered Dechipher. Decipher came back low risk not intermediate the biopsies were at. Treatment changed from photon (20 rounds) with hormone to radiation only.

Got second opinin at UFHPTI who also did PSMA and agreed with diagnosis and treatment but they do proton radiation not photon. Had 30 rounds on proton radiation.
Hope I was able to help but not familiar with RALP so can helped on that one.