There’s a recent video that shows that if you have cribriform the cancer is more aggressive than 3+4 would imply. If the cribriform Is larger than .25 mm then it is even more aggressive. Ask for a second opinion on your slides if the current person reading them doesn’t know the answer.

Here is a link to the video about cribriform and more.
https://www.urotoday.com/video-lectures/a-journal-club-for-patients-with-prostate-cancer/video/mediaitem/4452-unfavorable-histology-classification-aims-to-reduce-unnecessary-treatment-journal-club-jesse-mckenney-jane-nguyen-cornelia-ding.html
Yes Nubeqa Is easier on the user because there are fewer side effects than other lutamides.

The thing is it’s better off to start with Zytiga and When it is no longer desirable move on to Nubeqa.

Here is a link to an article discussing that.
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(19)30688-6/abstract?mc_cid=c2dca8aa74&mc_eid=99575fc699
Surgery or radiation—— It is a toss up. Results are above equal from each. If you have surgery later, you can have radiation. If you have radiation then you can have surgery, but its capabilities are limited. If you have surgery, then getting an erection may be difficult,. If you have radiation that would usually not be an issue. If you have surgery, ask for nerve sparing surgery, which would increase the chance you can get an erection after surgery. Brachytherapy Is another option it is frequently followed by radiation.

I would not hold off on getting treatment soon. Cribriform makes a Gleeson 3+4 much more aggressive, the video discusses it. Try to speak to more radiation oncologists, and urologists about your options. ADT would at least retard the growth of your cancer while you think about it.

Are you able to get CyberKnife SBRT? MRIdian Would be better, less nearby tissue damage but I don’t think they have that in Canada.

There are other things you can do which don’t involve radiation, but I don’t think they are available in Canada they are HIFU, cryotherapy, TULSA-PRO.