Prostate cancer treatment options: Help me chose

I had radiation to the prostate since my cancer had already spread. So far (3 years 3 months after diagnosis), that radiation, together with hormone therapy (ADT and Apalutamide), has kept my stage 4 cancer in full remission.

The overall survival stats for removal or radiation are comparable, though obviously one or the other might be a better choice in specific cases. Make sure you consult with a radiation oncologist as well, just so that you have all the options before you make your decision.

Another option is active surveillance with *just* the hormone treatment. The Decipher test can help determine how likely your cancer is to spread (and how fast).
https://www.cancer.gov/news-events/cancer-currents-blog/2022/decipher-aggressive-prostate-cancer
Best of luck, whichever route you choose!

Timothyhitower, hi.
You might (I think everyone with 3/4 gleason should) look at MRI guided 5 fraction radiation.
Northoftheborder's advice about consulting radiation oncologist is really good advice. Surgeons think surgery is better that's why they specialize in surgery. It is the same with radiologists. In some rare cases they will agree on the best course, but probably it will end up your personal choice.
If you haven't had a decipher call the office where you had the biopsy and ask them to request it.
If you haven't had a PSMA/PET have one ordered. That would be next.
This site is great for reading the personal experiences of men who decided for surgery or radiation and will give you insight as to what you might expect.
https://www.uclahealth.org/cancer/cancer-services/radonc/cutting-edge-devices/viewray
wishing you the best luck

Hi Timothy, seems you’ve already had your share of cancer, and now this…
All good comments from the board which you should research before making any decision. I do not know the nature, nor the extent of your complications from your previous surgery, but I am certain you do not want to revisit that scenario.
I am not saying that prostate surgery should be off the table, but some individuals do not do well with any kind of surgery no matter the organ involved.
I looked up your Ivor Lewis surgery and discovered that in this procedure your stomach is pulled upward and repositioned higher in the chest cavity; do you have excess acid reflux or issues because of this? I mention it only because today’s prostate surgery puts you in almost a Trendellenberg position, in which your head is quite a but lower than your feet; not a good position for someone whose stomach is so much closer to the mouth. Acid does not have that far to travel anymore.
Yes, you would be fasting and all that but it may not matter in your situation. I Just bring it up as an additional complication to avoid should you be offered surgery.
Radiation could perhaps be kinder to your body overall and address the cancer just as well. Best of luck!
Phil

"some individuals do not do well with any kind of surgery no matter the organ involved"

Yes, I'm one of those people. After the surgery to remove the tumour from my spine, I went through two months of cascading post-surgical complications which kept me confined a critical care bed before I could move to the rehab centre.

Obviously, prostate surgery is much less drastic than spinal surgery, but my first reaction was a prolonged ileus (shutdown of my digestive system) that resulted in IV feeding, a suction tube down my nose into my stomach, 40 lb of weight loss, and temporary diabetes that required insulin injections. That was the first time in my life I went under general anaesthetic, and I will avoid it in the future unless there's no other reasonable choice.

Decipher test so that you and your doctor know the aggressiveness of the cancer, which guides you to treatment options and urgency. Scan (ideally PSMA PET scan) to help determine if cancer is confined to the prostate capsule, which guides you to treatment options. Radiation oncologist to understand non surgical option. If you choose surgery, have performed at a Prostate Cancer Center of Excellence by a surgeon with at least 1K surgeries, because the skill of the surgeon can affect continence and ED outcomes, all other factors being equal. Your fitness and pelvic floor muscle tone is also a consideration when considering surgery (continence). If you choose radiation, as others advised, choose narrow margin machines for which many in this forum can provide you with specific details. For you initial treatment, even if you have to travel farther than you prefer, getting the right expertise can lead to better outcomes. There are books and online resources that we can recommend so that you know the right questions to ask during your next appointment.

Yes, North, you are definitely one of those “lucky” people!

I don't usually have problems with surgery, it's just the Ivor Lewis that went wrong

It is confined to just the prostate at this time. Urologist says it's intermediate aggressive but my history with esophageal cancer and it's aggressive nature is concern for treat over watch. My concerns are side effects of treatments as I am not an old man yet and still wanna play house.

As was explained to me, the prostate is a small organ with tubs and nerves connected to it, and therefore, the removal of this organ is a complicated procedure. Removing all of it isn't easy if trying to minimize the side effects that impact quality of life. Leaving just a little bit of the organ means there is a chance the cancer will come back. My thought was radiation and hormone therapy first, as this has less impact on your day-to-day life. That still leaves the option to remove it later. If you remove it now, obviously, you have limited choices later. I am big on quality of life, being able to be active, enjoying what each day offers, and NOT sitting in a wheelchair drooling on myself from medical procedures that do little more than keep me alive.

If you still “wanna play house” radiation (even with ADT during treatment) will give you a better chance than surgery.