Some people with prostate cancer do not produce a lot of PSA, Sounds like you’re one of them. They suspect that those people also don’t produce PSMA so the PSMA PET scan finds nothing. That may be true in your case, The scan does seem to show that it has not gotten out of the prostate, if you do produce PSMA.. An FDG pet scan can give more information if you don’t produce PSMA.

You have a Gleason 8. The other numbers are irrelevant they only go by the highest number. It would make sense for you to get a second opinion on those slides. I’ve heard people go both ways having the slides show lower Gleeson scores or higher. A Gleason 8 is aggressive you want to do something soon to prevent spread.

Doing nothing would be a very bad move. Get a Decipher test, it will tell you how aggressive the cancer is about returning, after treatment. Ask your doctor about it.

The long-term results after surgery or radiation are about the same. If you have surgery, you want to make sure they spare the nerves. That would probably allow you to get an erection eventually after surgery. That’s one of the big problems with surgery you lose the ability to get an erection, There are things you can do none of them Real easy. After radiation, most people are able to get an erection still, though it may go away after a while.

Are you working with a center of excellence to get the best opinion on what you should do? There are also a number of other treatments that would probably work for you, Immunotherapy , HIFU , Cryoabalation , NanoKnife , TULSA PRO. They don’t involve radiation and usually allow you to have surgery or radiation if they are not successful.

After surgery, I didn’t have any noticeable problem with incontinence, After radiation, I didn’t have a problem with incontinence for about five years, then it started to become a problem. Your results will vary, Everybody reacts differently.