Recently diagnosed: Treatment options for early stage prostate cancer?

ozback11, I did research on all the options and talked with several people who went through the prostate cancer journey. I also had two uncles that had prostate cancer. One was in his late 70's and had a lot of other issues that were going to end his life prior to PC - Thus, he went with watchful waiting. The other uncle did not catch the prostate cancer until it had metastasized to his bones, and he ultimately died from PC.

In the end, a radical prostatectomy aligned with my personal goals and expectations for life going forward. Being 57 and retired for less than two years, I wanted a treatment plan that gave me the best possible chance for 30+ years of prostate cancer free life. A radical prostatectomy is the most invasive option, but is the only treatment plan that removes the entire prostate that has confirmed cancerous cells (I had the prostate, seminal vesicles, and nine lymph nodes removed). Other treatment plans try to kill all the PC cells, but rely on imperfect imaging tools to direct the treatment. Also, a RP allows for a complete pathology to be performed after the surgery. For myself, this was very important. I wanted to know that all the known cancer was addressed/removed. I am a relist, cancer is cancer, and you never know if it will come back. This brings up another advantage of the radical prostatectomy - If the PC comes back, radiation can be used, but a RP cannot easily be performed after radiation.

I had a Gleason Score of 7 (4/3) and could not even imagine going with watchful waiting. Waiting for the cancer to metastasize just did not make sense to me. If I was in my mid 80's and had other underlying conditions, watchful waiting could have been an option.

It sounds like you have done your research and picked a center of excellence for your surgery. For myself, Mayo-Rochester was amazing and I could not be happier with the doctor and support staff. The recovery was not that bad, except for the first week with the catheter. After the catheter was removed, everything was went so much better. Also, referred shoulder pain was quite uncomfortable for the first few days.

Good luck and praying all goes well with your surgery!!

Jim

72/73 RP @ Johns Hopkins Aug 2022
Recovery excellent
I wanted all identifiable cancer removed.
With salvage tx as a backup.
And I did require salvage tx radiation together with short term ADT
1st post salvage tx PSA < 0.02 undetectable reported 1 week ago.
Obviously praying and hoping for long term undetectable PSA
It's a war with PCa and I wanted all available weapons.
Good luck and best wishes.

Thank you for the reply Jim. I really appreciate it. One thing I am struggling with is making sure I have picked the best surgeon to handle things. Any advice on who is the best of the best at Mayo Rochester ?

I did a lot of research on surgeons to make sure I chose the best one I could find. I did not want anyone that was still on the learning curve. Rather, I wanted a surgeon that focused on radical prostatectomies, had performed thousands of RPs before mine, and not a "jack of all trades" that performs a plethora of different surgeries.

For me, it was Doctor Igor Frank, located at Mayo-Rochester. He was the second surgeon in the US to perform the robotic assisted RP and the first at Mayo. He has also been a trainer for other Mayo surgeons. Dr. Frank and his staff were absolutely incredible throughout the diagnosis, surgery, and follow-up. As you know, there is always a chance for surgical errors, unnoticed cancer outside the prostate, micro metastasis, etc... Given all these variables, I felt very confident with Dr. Frank and his ability to recognize potential issues and make the right decisions during the surgical procedure.

I know you are only two weeks out from surgery, but I would make certain your current surgeon is the best you can get. There are a lot of great surgeons out there, but also a lot of mediocre and bad surgeons. Your quality of life, for the rest of your life, will depend on the skills of your surgeon and his/her staff. I drove 4 1/2 hours each way to Mayo-Rochester. In my opinion, the 4 1/2 hour drive was not far at all. Even if I would have had to fly to get the best possible surgeon, I would have done that.

I am one year out from my RP and consider myself to be about 95% back to normal. ED and bladder control were not a problem for me, but I really was not that concerned about it. I was significantly more concerned with having the best possible chance to live 30+ more years with my wife.

Best of luck with your decision and please let me know if you have any additional questions.

Jim

Hello and Good day All,
Well, i also, have Cancer in my Prostate
Have had two MRIs in 2021 and just this Past week, 2025 - my PiRad have increased from 4 to 5
2025: benign prostatic hypertrophy ... There is no irregular bulge of the prostate capsule ...

¿ What to do ?
Have n o t had a Biopsy...Yet...
Still -Urinate fine
-No blood in Urine nor Semen
-Have not lost weight
All seems Fine...
so ¿ to Biopsy OR not ?

Thank You,
Richard in Tucson (AriZona)
===

@rcas75
You mentioned having prostate cancer. You mentioned having two MRIs. How was it determined you have prostate cancer without having a biopsy done?

A MRI is used to scan prostate and look for susupicious areas and tumors. MRIs are usually done after suspcious PSA test indicate a problem. Did you have ongoing PSA tests?

The results from a MRI are usually used to consider biopsies or not. The biopsies determine if you have cancer or not and your Gleason Score of the cancer.

Once you have your Gleason score the options for the need for treatments come up. There are many other test you will see posters and R/Os suggeting to be done once you have a Gleason Score. They are PSMA, bone scans, Decipher, etc. They give additional diagnosis of the cancer risk, and if confined to prostate, etc.

What are your MRIs saying? If just BPH then treat BPH. You did not mentioned your PSA scores. Are they high, continuing to rise? If I were you I would be getting a lot more answers from those treating you before considering biopsies. Getting second opinions are suggested by most MCC posters and since you have questions of what to do is get a second opinion from a major medical institutions with experince in prognosis of prostate cancer and the newest treatment for them.

Hopefully all you have is BPH

A couple thoughts to offer you. You didn't say what percent of your biopsy was Gleason 4. If it's 10 percent or less you might be a candidate for Active Surveillance. I would also ask for a genetic test of your cancer.........either Decipher Prostate on Oncotype Dx. These tests will give some indication of the aggressiveness of the Gleason 4. You'd want this additional information before considering Active Surveillance. It seems to me you've caught this cancer very early even though the MRI indicated PI-RAD 5 for the lesion. You might also consider Focal Therapy such as TULSA-PRO to treat the lesion and surrounding margin with high frequency ultrasound to kill the cancerous cells and surrounding margin tissue. What you're balancing here is effectiveness of treatment against side effects.............and your young age of 57. I'd also say. You have time. Take time in making your decision. Best of luck.............

No symptoms is not a reason to not get a biopsy. I had zero symptoms but a rising PSA. MRI showed a single lesion and Pi-rad’s 4. Biopsy was Gleason 7 (4+3). You need to take the next steps. I did Tulsa Pro in July

Might want to check it out further.
Understand there are less intrusive tests than biopsy to do that, eg urine.
Check things out on Uro Today site
My guess us biopsy maybe the Gold Standard, especially now with Decipher that can use the tissue to really dive into it.
I had my biopsy in '18.
It was merely a bit uncomfortable.
Good luck!!