What would you do?

Did I miss PSA?

It was 9.36 on 5/1/2025

It likely is a candidate for Tulsa Pro. Tulsa is used for BPH and/or cancer. A few guys on this forum have had it done on prostates larger than 84cc for their cancer and the BPH reduction was a bonus.

Spouse of a mHSPCa to lung only discovered17 years post surgery (RARP). Things have changed a lot since we had surgery and it’s interesting that people wait and monitor now and that there are tests like Deciphor and deeper pathology study of biopsy to help guide. (See profile for details)

That said, looking back I am glad we got it out and had those 17 years. Some medical folk have told us ‘the seeds’ of the metastasis were probably there 17 yrs ago. Given he has no Mets in pelvic area, bone, or lymph, we are glad we had it out back then. Had we waited, would it have spread in that area sooner (he did have PNI and extra capsular extension)? Who knows the answer, but I feel we managed local spread with the surgery. It was not a horrible surgery, even back then.

This cancer is so different for each and there is SO much to learn. Be involved, keep reading, and be happy with your medical team (get 2nd opinions from centers of excellence) while knowing enough to drive your own boat. Good luck and keep us posted.

Yes, in 2010 I did have surgery. My father died of prostate cancer, He had radiation. I figured if he didn’t make it, I would have surgery and that way I could have radiation if it didn’t work.
Robotic assisted surgery, of course.

After surgery, they go through your prostate, that they’ve removed, and look through it for any issues. In many cases, the Gleason score changes based on what was in the whole prostate not just the pieces they were able to biopsy. Mine was 4+3 after inspecting the prostate.

3 1/2 years later it came back. I had radiation, 2 1/2 years later, it came back and I went on Lupron.

I was just reading about that but I also read they cant do that with a penile implant which I have. Disappointing.

I am 66 with PSA 7.1 and two positive biopsy cores 3+4 and 4+3 = 7.

I looked at radiation and surgery and ruled out surgery as soon as I learned about post surgery catheter timing and drains plus as much as a 50% chance of permanent incontinence and impotence. Plus I follow Dr Schulz of the Prostate Cancer Research Institute who strongly feels improvements in targeted radiation have made it safer and just as effective as surgery with far less side effects

I chose 23 daily IMRT radiation treatments + a high dose brachytherapy "boost" procedure on top of 6 months of Orgovyx ADT pills. Now two months post radiation my PSA has fallen from 7.1 to 0.04. My entire treatment was delivered at a "center of excellence" southeastern university cancer institute. I am very happy with my choice and pray my cancer has been placed in long term or forever remission

My advise is don't rush to surgery.

Thanks for answering my dumb questions!

When they took your prostate out and examined it did they know at the time that the had cancer metastasized out of the prostate? Or did it just pop up out of the blue?

The big thing that scares me is the incontinence. I know it can range from a relatively minor short term deal to a real long term nightmare. How would you rate your experience?

I'm 68 now and I wonder if I had the procedure and have good control shortly after will that control erode as I age.

The more research I do the more complicated this all gets. I thought having a penile implant would give me a leg up in this situation. That's also what the urologist said when he put it in. BUT I'm finding out you cant have some procedures if you have that implant. Like the TULSA Pro for example.

Thanks for your time and thoughts!

I had the surgery done at 62 15 years ago. They’re getting a lot better at it today, can do Nerve Sparing surgery for most people, can save at least 1/2 the nerves in some cases as well.

My cancer had not Metastasized yet. 3 1/2 years after surgery it came back And I had salvage radiation. 2 1/2 years later, it came back and I Started Lupron. There was suspected there might be something on my spine at that time, but the drugs totally controlled it so that it never went anywhere. Had it zapped a couple years ago.

No one can promise what your issues will be with continence. Everyone is so different but almost everyone becomes continent. I had no problems at all after the catheter was removed, I was about your age so that may help.

Some people do lose control as they age, but doing Kegle’s regularly can keep your pelvic floor muscles strong and you won’t have that problem. There is an awful lot of information about kegles on YouTube.

@billfarm
I am not familiar with Tulsa Pro/ablation. I see it mentioned many times but since did not have it or ever recommended to me can't give any information on it.

Wish I could help with the questions as would like to know myself. I am 2 years out from my radiation treatments. I do have some drippling and increased urgency on urination. R/O wanted me to try Cialas (spell) but when talking to my PCP today he said does not affect urgency just relaxes the bladder, prostate, uretha, etc. and allows bladder to fill up more.

I was left up to me if wanted to use it. I bring that up because I have by being on MCC learned some techniques to offset the problem. I urinate when I think I can versus the need to do it. My recent DRE (June) did not reveal increase in prostate but I assume my issues are in my bladder.