Intermediate Risk Prostate Cancer Treatment Decision

My personal story: At 71 years young, I had two cores of cancer, 1 at 3+4. I decided on RP to get rid of the cancer and BPH. It also gives me radiation options in the future if necessary. My pathology report showed cancer was 4+5, so one of my tests is incorrect; I assume it was the biopsy. I have had NO incontinence issues and an excellent surgeon. So far, I have had 5 PSA tests and all have come back < 0.01. Hoping and praying for more of this in the future. Hoping this gives you some food for thought. Best wishes!?

Have you looked into Tulsa Pro as a third option? Much lower side effects if you qualify.

As far as I know TULSA is not generally recommended for patients with gleason 8 (4+4) , especially with aggressive feature present as is IDC. But maybe there are new guidelines out there ? Also, for TULSA procedure the placement of a lesion itself can be a limiting factor.

It is a myth that the various treatments for PCa all result in the same exact cure rate.

Look up Dr Grim i think his name was. He compiled graphs of cure rates comparing the major treatment paths (surgery/radiation, etc) versus your risk staging.
He passed on but theres a foundation that maintains and continues his work.
There are real advantages of going one way or the other despite the industry mantra being… the outcome of surgery or radiation is about the same… Can’t count how many times i heard this false and ridiculous statement.
Think its prostatecancerfree dot org?

I agree to an extent. But many factors should enter into the treatment decision.
Before PSMA and Decipher it was probably true, but now not do much. Things like cribriform/IDC and high Decipher definitely point toward surgery more than radiation.

After talking to 2 surgeons and an oncologist, it seems they all promote what they do as the best treatment. I'm 3+4, .84 Decipher, PSA 5.6, intermediate risk. Surgeons say Surgery gives best LT outcome. Oncologist says why do you think their number one argument for surgery first is you can always do radiation later if it comes back.....just do radiation to start and cure it.

Spoiler alert, Dr. Grim who was a Brachytherapy specialist, says Brachytherapy is best long term. My first surgeon told me they don't do much seed radiation anymore.

We talked to BOTH - surgeon AND radiologist, BOTH said RP is a better plan for localized cancer with cribriform and IDC , of course given that person is healthy enough to go through surgery and recovery.

Cribriform cells are highly aggressive and very changed in morphology. Their DNA has many mutations and can evade radiation. IDC presentation is also rare and complicated formation and points to aggressive nature of cancer. All in all, it is better to physically remove those if at all possible before they spread outside of the prostate gland.

Also, if one has such an aggressive cancer it is comforting to know that IF down the road cancer appears again, one has back up line of defense- radiation. Once you have radiation you can not have it the second time. Radiation can fail first time around, the same way RP can fail in eradicating cancer, but after failed RP one has radiation as an option IF needed.

It could be you left this out. If you have salvage radiation after surgery fails, it does not prevent you from having radiation elsewhere on your body, It’s just the prostate bed, where they radiated after surgery, that can’t have additional radiation.

Yes, that is what I meant, you can not have prostate or prostate bed radiated twice. So if cancer survives radiation first time around, one can not radiate that particular area again.

Depending on how important sex is , I can only say I had the surgery with numbers similar to you , plus radiation and 2 hormone shots , the second shot still effecting me with a month left . No ability for sex in almost a year now and had no ED before surgery at 78 . Several friends went the radiation route , 2 of them getting normal erections. I’ve tried vacuum pumps and Trimex injection without success, the few time I was hard enough there was no feeling at all which made me feel like I made the wrong choice, now trying Bimex so far in 3 attempts no luck so will increase the dose , has anyone else have issues with getting penetration but no feeling at all which made me feel like a mechanical robot, need to know if I have an implant will my feeling return if not why do surgery. Dr was not able to spare one nerve , wonder if my body needs more time ?