Treatment Decision - Radical Prostatectomy versus Radiation Therapy

I was worried about that Gleason, but 3+4 is a good start to work from for a remission. Six of 12 cores with a 3+4 would not be favorable. Intraductal usually comes with cribriform which is very aggressive. It would really helped for you to know exactly what was found.

Can you get your slides reviewed by someone else and find out whether intraductal is actually there. There is a Doctor who is an expert at doing this, Charges $450 but you will know for sure what’s going on. Dr. Jonathan Epstein in New York is the GOAT when it comes to PC.
https://advanceduropathology.com/consultation/
There are other places you can go to get a second opinion.

Thanks! Will check it out. My original biopsy was done at Hopkins, so free pretty good they are accurate. But I can risk $450 to get a second opinion.

Are decipher scores pretty bullet-proof? Was shocked at how high my was (93%). Was thinking about doing another one using a different firm (cant remember the names).

That correction was important to your diagnosis. My Decipher went the other way. I was intermediate (3+4=7) downgraded to low risk. So did not need hormone treatments.

The hormone treatments do not kill prostate cancer (from my R/Os). The stunt it. The prostate cells love testorone and by starving them of it they don't grow as much as they would without it. Some get greater stunt of the growth than others.

Most of all prostate cancers are slow growing. It is why it has such a high cure rate for 5 years. But some forms are very aggressive and if it has spread outside of prostate that is another level of cancer.

Have you considered traveling to a center that has the equipment and facilities you want. Many places have programs for those coming from out if state and will assist with lodging, etc.

I drove an hour instead of 25 minutes 5 days a week to get proton radiation at UFHPTI. For me the extra time was worth it if I could lesson the probability of radiation damage that proton radiation offered above photon.

I live near the Johns Hopkins Proton Center, so I think I am ok there. Thanks. Assuming I go radiation route. Still considering surgery. Not sure which is better for my more aggressive cancer.

As an engineer you must be good with numbers. Age 66 is considered “young” these days and if you are in otherwise good health, even younger.
As others have suggested, you really need to pin down those biopsy pathology results, because if they come back with cribriform (intraductal being more aggressive), coupled with your very high Decipher score, you have a type of cancer that statistically has a greater chance of recurring after treatment (any treatment).
That doesn’t mean it WILL, but it could.
With that in mind, perhaps surgery might be the better option. Once the gland is removed, the pathologist will view it as a whole, EPE will be absolutely known as well as any breaks in the capsule, lymph node involvement, etc.
Hopefully, all will be negative. But if not you will then know if you should go on ADT and receive radiation or perhaps monitor your PSA’s on a 3 month basis. Any recurrence down the road (even many years later) can be treated with radiation.
I know Proton therapy is supposed to be kinder to surrounding tissues due to the Bragg Effect, so not sure if salvage surgery is more successful in these cases or not.
One other thing I would add: get a second surgical opinion. Your current surgeon sounds very honest and forthcoming (a lot are not) but the way you present it, it almost seems like he doesn’t want to do the surgery for whatever reason. Not sure if it’s a lack of experience in a complicated case, but you want to find the VERY BEST if they are gonna be cutting down there! Best,
Phil

My urologist at Sibley Hopkins gave me the biopsy report of intermediate unfavorable and subsequent Decipher was 78 high risk. I'm older at 78 but he was strongly recommending radiation over surgery. So I did Proton Therapy at Hopkins which I completed a month ago. I also met several men there with prior RP who were there for salvage radiation. Happy with my decision but underscore that it's yours alone to make in consultation with your treatment team rather than any recommendations you might get in this thread or others about which is the better option. Good luck!

if you don't mind me asking, who was your urologist and who was your radiation oncologist ?

I had High Intensity Focused Ultrasound in 2018. HIFU. All clear seven years later.

If you can private message me, I will give you those names that way and since we both seem to live in the area, will also offer to make myself available to talk if you'd like.

@brian5837
Echo your statement about has to be your decision alone.
Using your medical providers and consultations to guide you as this is a medical decision and should come from medical prosfessionals.