Intermediate Risk Prostate Cancer Treatment Decision

Posted by jt14 @jt14, Jun 10 11:08am

I have perused comments in these discussion areas and thought I'd reach out for thoughts on the decision of prostatectomy vs radiation therapy. Thank you in advance for your thoughts.
I am 70 years old in good physical condition (no heart, metabolic or obesity issues). Biopsy showed 5 out of 13 specimens positive ranging as below:
all on one side
Group 1 to Group 4
Gleason 3 + 3 to (just one) 4+4
one with "ductal features"
Most recent PSA 4.8
PET scan negative
I believe from a couple of opinions (top notch institutions)
that mine is fairly aggressive and needs treatment not surveillance.
Except for one surgeon who was adamant that his open surgery would be the best option I have heard that I could rationally choose either radiation or surgery as treatment and I am in that the process now of determining best road forward.
I initially leaned toward robotic surgery ("get it out," benefit of pathological report on the prostate cancer, no long term treatment as with radiation and ADT) but after a recent opinion from a surgeon the thoughts of potentially months of urinary incontinence and much larger chance of ED issues has me rethinking this.
On the other hand weeks to months of radiation treatment and ADT along with the side effects of that and 24-36 months of no/low testosterone and no ability for sex, fatigue, osteoporosis, etc. have me likewise hesitant.
My guess is there is no "right" answer in my case but would very much appreciate feedback from personal experience. Thank you all.

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matthewdore | @matthewdore | Jun 21 1:07pm

In reply to @jeffmarc "Sounds good and you definitely could consider active surveillance. Do you have BRCA2? You are getting..." + (show)

got tested by Uchicago last week. awaiting the results.

heavyphil | @heavyphil | Jun 22 8:17am

In reply to @brian5837 "Jeff, did you see the surgeon's comment: "He did say my high decipher means I should..." + (show)

Excellent point, Brian…just because a Decipher is higher doesn’t mean radiation is any less curative.
Cribriform/IDC perhaps would be another story.

jt14 | @jt14 | Jul 11 11:25am

Thank you all for your thoughtful comments. After visiting UMiami Health, Cleveland Clinic, U of Chicago and Northwestern Health (both surgeons and radiologists) I have decided on robotic RP. I have two artificial hips which doesn't rule out RT but makes it more difficult. Additionally, the high risk nature of my cancer meant I would have to do maybe two years of ADT with the RT. The main reasons I chose RT:
No long term ADT (at this point) and its side effects . If I didn't need ADT I probably would have gone with RT
ability to get pathology report of the prostate after RP
somewhat easier and more effective treatment with RT upon recurrence
After Job 1 (cancer cure) I looked at the side effects of the treatments and got statistics on each. It just seems like there is such a wide range of severity and duration of possible side effects within those percentages. I felt like getting a good surgeon with many many surgeries at a very good hospital gave me best bet. Just hoping I am on the low side of side effects; particularly incontinence and ED. Surgery is 7/30. Again thank you, all, for your thoughts and advice. Stay strong! and saying a small prayer for your best outcomes.