I am a healthy and fit 64 year old. I had a PSMA MRI in January 2025 that found a 1 cm lesion with "gross extraprostatic extension". A biopsy in March determined that all four cores from the lesion were cancerous (Gleason 4+3, cibriform present) and the other 12 cores were normal. Intraductal carcinoma and periprostatic fat invasion were absent. Decipher is not available in Canada and I was not able to get any information on the size of my Cribriform or any consensus on the importance of cribriform size among the doctors I consulted. I had a PSMA PET Scan in June that found no indication of metastasis.

I researched every relevant and reliable source of information that I could find and tried to filter out the noise and opinion, which is not easy. I also consulted four different urologists (surgeons) and two radiation oncologists. I even travelled down to the Mayo Clinic in Jacksonville FL for two consults (urologists and radiation oncologists). All of the doctors agreed that radiation and surgery were good options for me that would have a good prognosis. One of the urologists did not perform surgeries, but had a practice helping patients with post treatment prostrate related complications. That doctor said with surgery you get the bad s??t out of the way upfront and with radiation it tends to crop up 5-10 years down the road. He told me if his dad was my age, he would advise him to have surgery, but if he was 75 or older, he would advise him to go with radiation. All of the doctors also stated that if they were in my situation that they would opt for surgery. The surgeons were primarily concerned that radiation would preclude later surgery because of tissue damage. I was told that recurrence post surgery is often still localized and that follow-up surgery is one of the treatment options if a patient has had a prostatectomy. The primary reason the radiation oncologists gave was the unpleasant and potential long-term side effects of hormone therapy that would be part of radiation treatment for me.

I opted for a prostatectomy, which I had five weeks ago to the day. My recovery is going well and I am essentially back to normal in terms of urinary continence. It terms of sexual function, it is too early to tell, but because of the location of my lesion, the surgeon removed the nerves on the left side of my prostate, and I was told that this will negatively affect the likelihood and degree to which I will recover sexual function.

Bottom line: Everyone's case is different and I am comfortable that I made the right treatment decision for me, though one can never know for sure. My advice is to make sure you are comfortable with the information you get from your consults and seek additional consults if necessary, until you are. There is no certainty as to which treatment will have the best outcome for any of us; you can only make the best decision for you based on good information, and a full understanding of the potential pros and cons of the options available to you. Make sure you have enough information to make a well informed decision. I wish you all the best.