Gleason 7 (4+3), ECE, PSA 3 – Considering IMRT + ADT vs. Surgery –

Hi everyone,

I’ve recently been diagnosed with Gleason 4+3=7 prostate cancer, with extracapsular extension (ECE) and a PSA of 3 I'm 63 year of age. My Urologist tends to lean toward the tumor being solely contained whereas the Radiation Oncologist is treating it as truly being ECE. The radiologist that read the MRI stated "Broad-based capsular abutment raising consideration for ECE without capsular irregularity or bulging event". The pathologist also mentioned "FINDINGS SUGGESTIVE OF EXTRAPROSTATIC EXTENSION" but did not make any mention of the biopsy sample containing either membrane material or fatty tissue from outside the prostate gland so I'm sort of confused as to how they could make that statement. The Urologist told me that every effort is make to ensure the biopsy does not extend outside the prostate gland/membrane.
I'm leaning toward assuming that ECE is truly my case. I’ve been weighing treatment options and would really appreciate hearing from others who’ve been through this or have insights.

Current Options I’m Considering:
• IMRT (Intensity-Modulated Radiation Therapy) + Hormonal Therapy (ADT)
• Radical Prostatectomy
• Possibly Proton Therapy as well (Would need to travel to Atlanta daily ~50 miles)

What I’ve learned so far:
• Cure rates for IMRT + ADT seem to be around 88–92% in my risk group.
• Proton therapy offers similar outcomes, with maybe fewer rectal side effects short-term.
• Surgery carries a higher risk of positive margins when tumors abut the capsule (as mine does).
• Hormonal therapy (ADT) adds side effects like fatigue, ED, hot flashes, and mood shifts — most of which seem reversible if therapy is short-term.
• Long-term radiation side effects include 5–10% risk of urinary/bowel issues and ~50% chance of ED.

I’m trying to balance cancer control with long-term quality of life. I’d love to hear:

🔹 What treatment did you choose and why?
🔹 How have you handled long-term side effects (urinary, bowel, sexual)?
🔹 Would you do anything differently?
🔹 Any regrets or surprises along the way?

Thanks so much in advance — it means a lot to hear from those who’ve been through it.

- Tim