Surgery / Radiation for Prostate cancer?

Need PET/CT scan results first

Glass half full: radiation and surgery are equally effective for long-term survival.

The side-effects and follow-up are different, though, so that's where you probably want to focus. That's a very personal choice, which ones you might be more willing to live with (though fingers-crossed most of them may not even happen).

My (non-expert) advice is to study up on the topic and then get expert advice, ideally from several experts in the various types of treatment you're interested in. Travel to a major cancer center if needed (I had a good experience at MD Anderson). Make a list of questions beforehand - you can find many such lists on this site.

Resources besides this site, which is a great one!
https://pcri.org/
https://www.inspire.com/groups/zero-prostate-cancer
https://www.reddit.com/r/ProstateCancer/
Books:
Dr. Patrick Walsh's Guide to Surviving Prostate Cancer
100 Questions & Answers About Prostate Cancer

It is really strange that they took only 5 samples, but it is what it is. I am sorry that you are facing PC but there are many ways to combat it .
Yes, you need to wait for scan results and hopefully they did PSMA CT . Did they do Decipher test on your samples ?
Also, if in your pathology report you see anywhere mentioning of cribriform cells or intraductal (IDC) formations it might be better to have surgery in case that cancer is still contained in a gland.
BUT again, at the end you will decide what is the best course of action for you personally. Every case is different and every person has their own preferences and /or priorities.

@curlyo
Your doctors are probably waiting on your test results to give you treatment options.

You stated cancer was still in prostate. This is really a hard thing to determine without the test results you mentioned. If outside of prostate or just confined to prostate makes a big difference. I had a bone scan, PSMA, and a Decipher test done before final treatment plans were agreed on. My decipher tests like yours was 7s.

With your Gleason score I will mention a test called Decipher test to you. Talk to your doctors about having it done in addition to your other tests. It gives a more precise diagnosis of whether your cancer is low risk, intermediate or high risk.

I know it is hard to wait but right now but those test are needed and are quite common for urologist or R/O to order. Most prostate cancers are slow growing and respond well to radiation treatments and hormone treatments. RP (surgery) is an option but comes with a lot of additional side affects that radiation only would not have. That is why really do some research on your own and then make a list of questions for your urologist and or R/O.

One poster mentioned doing this research also. You can go on web sites for Mayo Clinic, Cleveland Clinic, John Hoptkins, WEBMD, and research prostate cancer and treatments. Really look at the pros and cons of each. Hormone treatments also come with pros and cons. It is why I mentioned Decipher test to you as has an influence on wether hormone treatments are recommended. This will give you a good basis to be able to asked questions.

Just remember this is your body and your cancer and what another person does may not be best for you both physically and mentally. You are 70 years of age with a lot of life left. Know that prostate cancer in men is very common. Over the last years the ability to treat it has become excellent. With that try to think of the glass half full not half empty.

There are many outstanding medical facilities that will sent you pamphlets and information packets. One such is UFHPTI. It does proton radiation since 2006. It will send you a FREE information packet (FED EX) with tons of research, information on photon and proton radiation, two books on prostate cancer (one is the Walsh book). There is no pressure to go to them at all. I found their information packet very helpful.

But I also did a lot of research on my own. I also had an outstanding PCP who did a ton on research himself so he could a knowledgeable medical doctor and be able to suggest and recommend prostate cancer treatments, etc.
Good luck and good luck on your test.

It was probably a targeted biopsy based on mpMRI. The upside is that it is less invasive, the downside that you might miss cancer that is not showing on MRI.

@curlyo I agree with @jc76 and @curlyo regarding the Decipher test which takes biopsy material and tests for aggressiveness and treatment options. The doctors DO use this test to adjust treatment options, ie adding androgen deprivation therapy, as one example.

If you do radiation, request spaceoar or bioprotect gel spacers a week or so ahead of time. This helps create additional separation between your prostate and rectum and therefore limits healthy tissue exposure, which impacts side effects and quality of life.

I had the mridian sbrt radiation machine which has a built in MRI real time imaging vs fused images. You want real time images, if possible, as what they see they can treat and they can dynamically change the treatment mapping in real time. The Elekta radiation machine is another built in MRI machine. They will treat your whole prostate PLUS margins. The Mridian and Elekta use 2 mm margins while other types of machines use 3-5 mm margins, including Proton.

Centers of excellence are usually the way to go. You also might want to do a telehealth with an oncologist from a center of excellence, as a second or third opinion. I was 69 at the time of treatment. I had slight urine restrictions after the 3rd of my 5 treatments. Flomax took care of that overnight. Other than that, no side effects and am back to normal. I was treated February 2023.

From the limited information you gave, your cancer sounds a lot like mine. I had four of five cores in the targeted area come back Gleason 7(4+3). All 12 other random core samples were negative. After doing extensive research, I chose to do Tulsa Pro at Rochester Mayo in July 2024. I have had zero side effects and the procedure was a breeze for me. My PSA went from 8.62 to 0.68 at nine month. Medicare paid for the procedure. You can read all my comments if you click on my profile.

Dr Walsh's book is an excellent recommendation for education.
And I echo Northoftheborder's comment.
I had surgery at age 72 at a center of excellence (COE) and would do so again.
I wanted the chance of a cure by complete removal. And having RP reserved Salvage Radiation Treatment as a secondary option; which in my case was needed, possibly because I had EPE (extraprostatic extension; cells outside the prostate discovered by the post-op pathology.
My surgery went well and my recovery was very good.
However, there are very satisfied patients who have had radiation treatments of different types.
A PSMA Pet to rule in/out additional metastatic disease would be helpful.
Best wishes on your decision making and results.

Thanks for sharing the info on UFHPTI! I've been under surveillance with a local urologist since 2021 after a PSA of 7.1 and Gleason 6 (3+3) and my PSA has been between 3.2 to 4.6 during this timeframe. I recently switched to the local VA Urology department and my first PSA was 9.1. MRI scheduled for June 4 and may need to make a treatment decision.