Gleason 8 diagnosis at 51: Likely opting for surgery

I'm similar: 66 yo, PSA 11, Gleason 3+4, Decipher .74, 6 spots on gland, probable cancer in capsule, no cancer in seminal. Dr. recommending Proton therapy + Orgovyx. Problem is I feel fine. What happens if I do nothing and just continue active surveillance?

Good outcome from surgery and radiation. After 15 years psa on the rise and now on Xtandi and Xgeva for metastasis into bone. Hoping for another decade at age 82.

Not sure if you’ll remember this, surfer, but about 7-8 years ago there was a huge upheaval in the world of urology; it colored every aspect of prostate cancer and most importantly, its diagnosis.
In a stunning reversal, a distinguished panel of experts accused the urologic community of overtesting and overtreating.
There was even a book written called “The Invasion of the Prostate Snatchers” - believe it, it’s on Amazon. Suddenly, urologists found themselves accused of mutilating men for profit. Even the man who discovered the PSA antigen test wrote articles about overtesting and how his test was never intended to be used in this fashion…WTF?
I myself was in the middle of this sea change. I suddenly became terrified of my annual digital exam and PSA - they were going to find something and ruin my life over something that “I would probably die with, not from”.
I did have urinary symptoms but kept them to myself - I did not want to be mutilated for profit! Eventually I couldn’t urinate so I was forced to see a urologist. A wonderful woman, she diagnosed BPH ( NO biopsy - hooray!) and performed a Green Light Laser To alleviate the symptoms. I was cured….
Flash forward one year, my PSA moved up to about 5.1. She told me that she really should do a biopsy but since my DRE was absolutely normal - and I had voiced my awareness of the overtreatment accusations in the press, she deferred to my wishes.
Added to this was the fact that I had met many men who had been biopsied rectally and quite a few wound up hospitalized with blood infections. My closest friend at the time, biopsied by the Dept head of Mt Sinai hospital, spent 14 days in the hospital with a punctured bladder, internal bleeding and sepsis….
Doctors now had to ask men if they wanted their PSA tested, and if it came back higher than 4.0 they would HAVE to refer them to a urologist simply to avoid being sued for negligence. All of this REALLY happened.
But after about 3 years of this “don’t ask, don’t tell” policy, the rates of lethal prostate cancer began to rise - what a surprise!! So we find ourselves today at the other end of the pendulum swing - testing beginning at 40, genetic testing just in case, MRI’s, PSA, PSE, various urine tests….you get the idea.
So when you say “If I was a doctor….” You are imagining yourself in TODAY’s environment; you are reading articles written BECAUSE of what happened a short 7-8 yrs ago; you are calling certain doctors lax or lazy - but you should be calling them wary or perhaps gunshy from having experienced that very real witch hunt accusing them of mutilation for profit. My own cancer probably progressed to the Gleason 4+3 unfavorable and two rounds of treatment because of this very real medical/political battle going on at the highest levels. I guess I could cry victimhood, but I made my decisions knowing (or maybe not knowing) what was being recommended and followed AT THAT TIME. It’s totally different now.
I don’t doubt your sincerity or your compassion for those who suffer - it is admirable. But there is also something in medicine called “triage” and it refers to focusing the attention on the most seriously afflicted, those whose situations are life threatening. Your husband’s normal DRE’s and fluctuating PSA’s had probably been seen in countless other men with no cancer present, so perhaps they were not convinced to more actively monitor him; his status was not considered dire at the time but the biopsy changed that and that is it’s purpose. I doubt your husband’s ex-urologist is beating himself up for missing something since he did find the cancer, right?Doctors practice triage unconsciously and routinely every day, no matter their field or specialty. They don’t have the luxury of treating a case of acne the same as heart failure since triage dictates that the heart patient get care first.
When you sit in the ER for hours and see patients being treated before you - even though you were there before them, that’s triage at work. We don’t like it, our possibly broken foot is throbbing, but the heart attack takes priority.
So I ask you to look at your crash course in prostate cancer this past week in light of the here and now, remembering that doctors decisions are invariably colored by many past experiences, both good and bad. I am not talking about gross negligence, but simply the way some treatment decisions are made….Twenty twenty hindsight is always perfect and if only we knew then what we know now….Best
Phil

Best of luck to you. I hope I can still mske it to 82. You were cancer free for 15 years after salvage RT?

Not doing a PSA test at ANY age is total incompetence WHY not just do it. It is so simple and could be a red flag for problems. Fear of over treating? Sad this nonsence about PC is still around, JUST DO THE DAMN TEST!! DUH!! The easiest fix for PC potential problems is still being argued over. WTF!

Laccoamena5, Did you read what I wrote? These are true events that occurred. I DO NOT disagree with you about doing the PSA test and how important it is. It should be done PERIOD!
I am simply relating to those members new to the world of urology, that a real backlash occurred in that time frame (2017-2020?) which caused drs to have to give patients the disclaimer that the PSA test result could open them up to a cascade of medical procedures - referral to a urologist, perhaps unnecessary biopsy or even surgery.
I know this for a FACT since my doctor explained it at length to me when I asked him about a PSA test.
And for the record, “this nonsense” is NOT still around since it was soundly debunked by the rise in advanced PCa cases after this 3 year period of turbulence. This is historical perspective for those who think that this area of medical expertise is cut and dried and tied with a neat little bow. In fact, many of those same people confuse their degree from Google University with the real thing.

Laccoamena5, Did you read what I wrote? These are true events that occurred. I DO NOT disagree with you about doing the PSA test and how important it is. It should be done PERIOD!
I am simply relating to those members new to the world of urology, that a real backlash occurred in that time frame (2017-2020?) which caused drs to have to give patients the disclaimer that the PSA test result could open them up to a cascade of medical procedures - referral to a urologist, perhaps unnecessary biopsy or even surgery.
I know this for a FACT since my doctor explained it at length to me when I asked him about a PSA test.
And for the record, “this nonsense” is NOT still around since it was soundly debunked by the rise in advanced PCa cases after this 3 year period of turbulence. This is historical perspective for those who think that this area of medical expertise is cut and dried and tied with a neat little bow. In fact, many of those same people confuse their degree from Google University with the real thing.

Laccoamena5, Did you read what I wrote? These are true events that occurred. I DO NOT disagree with you about doing the PSA test and how important it is. It should be done PERIOD!
I am simply relating to those members new to the world of urology, that a real backlash occurred in that time frame (2017-2020?) which caused drs to have to give patients the disclaimer that the PSA test result could open them up to a cascade of medical procedures - referral to a urologist, perhaps unnecessary biopsy or even surgery.
I know this for a FACT since my doctor explained it at length to me when I asked him about a PSA test.
And for the record, “this nonsense” is NOT still around since it was soundly debunked by the rise in advanced PCa cases after this 3 year period of turbulence. This is historical perspective for those who think that this area of medical expertise is cut and dried and tied with a neat little bow. In fact, many of those same people confuse their degree from Google University with the real thing.