Intermediate Risk Prostate Cancer Treatment Decision

Isn’t the ED risk similar for RT and RP after 3-5 years? Especially if ADT is involved RT can cause even higher ED if I am not mistaken.

In my experience, surgeons told me that anything but surgery would be sheer madness, whereas radiologists were telling me that both were good options. My cancer is 4+4 contained in prostate according to psma and mri.

I don’t know if this will help, but here is some information from somebody in this forum who has a lot of experience with Trimix
https://connect.mayoclinic.org/discussion/my-trimix-experience/

I was diagnosed Gleason 8 cancer and elected to have surgery. But that didn’t get all the cancer, so 6 months later prostate bed radiation which also failed. Then Lupron / Eligard for a year, then stopped the Eligard but both my Testosterone and PSA remained at zero. I regained the ability to have sex by using either Bimix or Trimix. 3 years after this milestone my cancer returned. A lesion was located near L4 on my left side with PSMA and then I had radiation targeted to that spot. My PSA kept rising even after this radiation so we tried immunotherapy with Provenge which knocked my PSA down 90% but not to zero. A repeat PSMA scan plus a high resolution MRI found nothing near L4 or anywhere else, and a bone scan was also negative. Currently I’m on xtandi + Eligard and my PSA is stable at 3.8+/-.2 for 2 years. It’s been 10 years since I was first diagnosed.

This is the first time I have heard that Provenge knocked down the PSA right away. It usually is considered something that sort of inoculates one somewhat for future rises, but this immediate response is good to hear.

I also had my L4 compromised, Quite a bit actually. They zapped it in three SBRT sessions because they didn’t want to hit it with too much radiation at once since the L4 was already weakened. My PSA dropped to undetectable in a month and a half, on ADT and Nubeqa before and after.

In your Case you probably have multiple micro metastasis that can’t be seen yet by the PSMA pet scan. A metastasis has to be larger than 2.7 mm, and some case 5 mm, in order to be seen, at the last PCRI conference a doctor (Scholz)said when you can’t find it do an MRI it’ll be found in the lungs or the Retroperitoneum in many cases. I can’t imagine they haven’t looked there considering they did a High resolution MRI.

Have they done an FDG scan? Sometimes the cancer doesn’t produce PSA so that scan can’t see them. An FDG scan can see metastasis That don’t produce PSMA.

Thanks but I had a reaction to Trimex had an ER visit so now just started on Bimex

You will find many answers in this video , hope it helps .

I’m sure all of us wish we could give you a definitive answer. I was diagnosed at age 73 last December with Gleason seven (3+4, 4+3) iliac lymph node positive. I started Orgovyx, Christmas Eve and radiation mid February, finishing 44 treatments, April 22. PSA has dropped from 6.4 to 0.01 as of May 22 and will be tested again in July. Fatigue was absolutely horrible in the middle of radiation along with ADT. Now six weeks post radiation, some energy is returning. ED is an intimate friend, But trimix seems to work and I have my first prescription. My wife has been absolutely heroic, supportive and helpful. I’m supposed to be on Orgovyx for two years, but am trying to negotiate either adding Darolutamide after 12 months or simply switching to Darolutamide alone after 12 months. I considered surgery, but the surgeon wasn’t confident that he could access both lymph nodes due to previous hernia repair.