Surgery? Radiation? Can I have an independent suggestion?

"Cancer has a price tag."

Very true in a figurative sense. Fortunately, that won't apply in a literal financial sense for @hanscasteels going to top cancer centres like Princess Margaret Hospital in Toronto.

Having to shell out thousands or tens of thousands of dollars on top of dealing with the challenges of cancer and cancer treatments would be brutal, and everyone in that situation has my heartfelt sympathy.

I am 81 years old and coming to the end of the proverbial five year life cycle of stage IV prostate cancer which has metastasized throughout my bones and lymph nodes.
I have had every oncology treatment available except for chemotherapy which was my choice to not undergo.

Cancer has a price tag. Before cancer IS the good old days. Whatever your current cancerous condition IS where are at now. There is no "cure" for cancer. There is only delay. You will have better days and worse days no matter what treatment protocol you are on . All on that downward spiral that leads to our recognition and acceptance that no one gets out of this alive.

Tough words to hear, but the sooner you can accept this the better because that allows you to make the best of your UP days and to cope with and accept your DOWN days .

I am only 4months post prostate surgery and just found out my PSA still .36 so I still have cancer cells . Pet Scan tomorrow and assume radiation will follow. I’m an active 78 yr old and having a hard time not being able to have sex with my younger wife of 42 yrs. Pills and pumps so far not working, everyone says be patient but waiting one to 2 yrs is a lifetime at my age

More power to you, old man! Have you tried the injection Trimix? I have not used it personally but two men I know proclaim “instant wood”! Probably an exaggeration but better than trying to shoot pool with a rope- as George Burns used to say…

I am 81 years old and coming to the end of the proverbial five year life cycle of stage IV prostate cancer which has metastasized throughout my bones and lymph nodes.
I have had every oncology treatment available except for chemotherapy which was my choice to not undergo.

Cancer has a price tag. Before cancer IS the good old days. Whatever your current cancerous condition IS where are at now. There is no "cure" for cancer. There is only delay. You will have better days and worse days no matter what treatment protocol you are on . All on that downward spiral that leads to our recognition and acceptance that no one gets out of this alive.

Tough words to hear, but the sooner you can accept this the better because that allows you to make the best of your UP days and to cope with and accept your DOWN days .

I can only share my own experience and how I got to my conclusion, the rest is for you to be an advocate for your own health and take the steps needed that you feel are best for you.

I also had a Gleason 3+4 and, at 54, was told that surgery was preferable to radiation because I had enough years left that I would likely experience the long term impact of radiation before my natural life was over. This was explained to me that this might be recommended to a 75 year old man because their natural life was shorter.

People told me here "surgeons will recommend surgery, radiation oncologists will recommend radiation" and it sounds like that's what you got. But I can say that I spoke to nine experts: 3 x urologist, 3 x radiation oncologists, 3 x medical oncologists - and this doesn't include other disciplines that have loads of experience with prostate cancer patients but don't do the procedure. In my case, every single one of them gave the exact same advice. Now, these doctors were not in the same hospital, network, practice or anything else - I intentionally varied my search across locations to make sure the opinion was as unbiased as possible.

Adding to this, I also read dozens upon dozens of research papers (not opinions, actual research) that back up their recommendation.

Their advice was unanimous but beyond that it made sense to me: we don't know how bad the cancer really is until we remove the prostate and analyze it. Radiation doesn't do that. Biopsies don't do that. PET scans don't do that. MRI's don't do that. All the other methods give little glimpses here and there, but removal tells the whole story of the prostate, even if it doesn't yet reveal if it's gone beyond there all the time (hence the need for PET scans).

I haven't yet had my surgery, it's in about a month, but while I'm concerned with life after this I am 100% confident that my decision to have it removed is the best one for me.

There are other procedures, but while some people have had wonderful success with them, they are still considered experimental or "on the edge" and in most cases I found the efficacy of these alternative procedures could not backed up, some of that is the lack of extremely in-depth research of the available data - which is limited because they are new enough as to not show too much long term data (as in 15 years worth).

This was my experience up to this point.

You made me laugh, I’m told to wait awhile but I’m impatient, pump get you looking normal but not hard , I will try the gel first then the injection. My French and Italian blood makes every day difficult, I’d rather cut off a few fingers than have this unfortunate cancer. I still hunt and offshore tuna fish but making love

I totally agree with you, traveler, and I stay away from the word ‘cure’ myself.
The inevitability of our own demise is something we all live with and freely banter about……until that inevitability is right before us and we know that “this is it”.
I’m not there yet (at least I hope not), but you are -and I know it cannot be easy. After all your years of treatment you probably hoped for a better result but those treatments DID get you to 81 years. We can never be sure about such things, but would you have done anything differently? Would you not have endured the gauntlet and left this earth years ago - maybe not seeing your children grow up or your grandchildren being born?
If you are in a good place in your head right now and have gotten the satisfaction you desired out of life, your choice to forego chemo is totally understandable.
Honestly, I cringe at the Pluvicto ads which triumphantly proclaim this magnificent increase in survival rates. But When I see this increase is only for FOUR MONTHS I have to scratch my head!
I know many have used it - some with better results than others - but I wonder if all the side effects justify a lousy 4 months of diminished existence… I guess you’ve decided that it does not…Peace

I appreciate your comments !
I’m also trying to decide on a treatment at Mayo .
Gleason 3+3 /6
8/12 cores positive for cancer
PSA 16
The team says I shouldn’t do surveillance given positive cores percentage and PSA .
I seem to be leading in your direction of surgery however would like other choices that are proven options . Agree with the comment that the only way to be sure in to remove prostate and identify in actuality what type .
I would ask , What is the most predictable treatment with the best quality of life ???????