Cribriform cancer . Newly diagnosed.

sicescu2,
risk of cognitive decline after anesthesia increases with age.
Recovery from radiation is easier--no catheter after and no surgical wound healing
Radiation is painless, whereas pain and discomfort are normal especially in the first three days after surgery. You'll probably need pain medcations and a caregiver with surgery.
But talk to the oncologists, at least one surgical oncologist and one radiation oncologist.
Cribiform pattern is a more aggressive cancer. It might be best to start ADT right away to avoid metastasis.
Bless your choice.

It's a tough call at any age. Welcome to the club no one wants to be in.

Having had the operation at 59 and Salvage radiation shortly thereafter, I believe at 77 I'd probably just do radiation and ADT meds. My ADT was Orgovyx.

With a PSA of 4+, my guess is you caught it pretty early, this would make me think radiation and ADT might be a good treatment option.

Either way, I agree that @gently 's suggestion of starting ADT meds quickly is likely a very good idea.

Also the suggestion "But talk to the oncologists, at least one surgical oncologist and one radiation oncologist." is excellent. I'll caution this though, in my case, each said that their specialty was the way to go. You'll just get more information from them to make your own decision.

Best of Luck to you!

Having said that.....with younger folks anyway, I like to point out that if you get the surgery, then have a BCR (Biochemical Recurrence) you can then go into salvage radiation. (my history) If you have the radiation then have a recurrence, it's a more difficult treatment generally.

@sicescu2

If you are considering radiation, you may want to look at the Mirage randomized trial results that talk about a radiation machine with built in MRI vs one that uses fused images. The toxicity and side effects are dramatically different. Here is a link to an article from Urology Times.
https://www.urologytimes.com/view/mirage-trial-margin-reduction-with-mri-guided-sbrt-reduces-toxicity-vs-ct-guided-sbrt
I did the Mridian machine and went in understanding that if I had a biological re-occurrence, I would have to use other methods of treatment, ie ablation type choices... So far so good. I was treated in February of 2023. Little or no side effects. Started with an 11.2 psa, as of yesterday, my PSA is .66. Private message me if you want more specifics.

I had very similar numbers. I chose TULSA Pro at Mayo Rochester. No sign of cancer at 6 months and zero side effects. Medicare covers the cost. My story: https://connect.mayoclinic.org/discussion/tulsa-pro-experience-mayo-clinic-mn-july-2024/. Good luck.

I had surgery at age 72 at a Center of Excellence.
Initially, surgeon pushed back based on my age. I advised that I had no comorbidities and parents lived to 95. And we proceeded with surgery.
Radiation could be a more predictable outcome.
Hormone therapy (ADT) can be difficult and a significant impact on quality of life. Some men are treated with short term ADT 4 - 6 mos, some longer term 18 - 24 mos and some not at all. ADT utilization appears to be evolving.
Recommend Patrick Walsh MD's book Surviving Prostate Cancer and the free Patient Guide by the Prostate Cancer Foundation pcf.org available by download or in hard copy for information.
Best wishes on navigating a difficult decision.

@sicescu2, welcome to the club that nobody wants to be a member! I am a PCa patient, like you, that has received a diagnosis and is sorting our treatment options. I'm 3 years younger than you, have a dx of intermediate grade PCa like you, and a low Decipher Score (18) like you. I have been educating myself by reading the questions and responses on this forum and then following-up on the links provided these generous men for more information. You've been given excellent, BUT UNIQUELY DIFFERENT input from 5 very knowledgeable men that have walked ahead of us down the path of diagnosis and treatment of PCa, each content with their choice.
My personal take is:
1. You are very wise to post your situation on this forum and solicit advice and direction to educate yourself.
2. I have probably read every post of the 5 men that preceded me in responding. I learned from each of them and I guarantee you they did their homework, researched their options, and chose their treatment wisely for their diagnostic classification, age, health status, unique complicating factors, and personality.
3. Dr. Walsh's book is a must read. I'm going to read it for a second time. I will add the videos on PCRI.org as an additional resource. Chose the videos most appropriate for your diagnosis.
4. The importance of receiving diagnosis and treatment at a recognized Cancer Center of Excellence cannot be overstated. There is a significant difference in care and patient reported outcomes at Mayo and Johns Hopkins for example compared to regional care providers. Many people on this forum asked for a second read of their biopsy slides at a center of excellence.
5. There are lots of treatment choices, but no "Easy Button". Every man's situation is unique.
6 I would have chosen TulsaPRO because my PCa is limited to the prostate and Tulsa has a very low incidence of side effects. Alas, prostate calcifications eliminated that opportunity.
7. I am choosing RT because of the risk of post operative cognitive decline (POCD) that @gently mentioned. My read on the literature is that the incidence of POCD subsequent to non-cardiac surgery in patients over 65 is: 60% experience some level of delirium immediately after surgery and 10-30% still experience POCD 6 months after the procedure. The risk appears to be age related. No other comorbidity has been positively associated with POCD to help discriminate those at risk.
Hang in there and keep us updated. There are lots of people on this forum that care about you!

At 77, Which is my age right now, Surgery is something I I’ve done a few times because of I needed to replace both knees and one hip. I had a knee replaced at 76 and that’s a long surgery, hip replaced 6 months earlier.. I can do the surgeries because I am in good shape, besides the cancer. If you are in real good shape then surgery could make sense.

It is not recommended to have surgery at your age because it is hard on your system and radiation should last as long as you would normally live. Most people with PC die of something other than Prostate cancer. My brother had radiation at 76 and has been undetectable for a couple of years. If you find there is something localized in the prostate then radiation sure makes sense. There are also many other options that don’t use radiation and would allow it to be used later. They are HIFU , Cryoabalation , NanoKnife , TULSA PRO, HoLEP. There are a few people here in this form who’ve had Tulsa pro and really like the results.

I read in the Urologytimes.com that octogenarians ( I know you aren't quite there yet) in good shape should be eligible for surgery and that age shouldn’t be a deterrent. Radical prostatectomy can be a reasonable option for select octogenarian patients, according to researchers from the Mayo Clinic, Rochester, MN. The findings, which run counter to the conventional practice of generally avoiding surgeries for individuals over 80 years old solely on the basis of age, were published recently in Urology (2006; 68:1042-5).
This said, if it were me I think radiation is a better choice for all the reasons mentioned in this thread. I am 84 and healthy and will be getting some form of radiation in June after a period of ADT. I think your urologist is suggesting the right call.

My thoughts....why go thru surgery and it's recovery and lasting potential Ed and incontinence, when you will probably still need radiation and ADT anyway?
Possibly consider skipping surgery and go with the other treatments paths.
That was the advice we got from a Mayo Rochester surgeon.
Went with radiation and Eligard injections. So far (2 years), so good! (Gleason 8, cribiforms, stage 3Tb)

Jeffmarc and gsd summed it all up perfectly; all the other members gave excellent opinions based on their experience.
I’ve had both surgery -and radiation. I would NO WAY IN HELL have surgery at age 77 - especially with a low Decipher score; keep it focal with TulsaPro or MRI guided HIFU (Sloan Kettering NYC) or radiate it either with 5 session SBRT (cyberknife) or multi-session IMRT.
I try not to insinuate myself into other people’s treatment decisions but at 77 you simply don’t need to put yourself thru such a traumatic surgery; this “robotic” talk never addresses the realities of the procedure - it is NOT fun, it is not “non-invasive”.
And actuarially speaking, you will probably be dead from something else long before you suffer recurrence or distant future effects from radiation. See, I’m not sugar coating it because that's the way you have to approach this decision, and at 77, no matter how physically fit you think you are, there are dangers in doing a surgery that can last up to 4 hours or more. Just my two cents based on my own personal experience.
Phil