44yr PSA180 Gleason9 non-metastatic. Surgery or Treatment?

There really isn’t any way to do that other than salvage radiation that would radiate the prostate bed.

The thing is unless your PSA rises they’re not going to do radiation.

They would not give you docetaxel unless you had multiple metastasis. That’s what it is to treat. It is very hard on the bodythey don’t want to give it to you if you don’t really need it.

ADT would stop it from growing.

You have to realize that 30 to 40% of people who have Prostatectomies have recurrence. The rest do not. There’s no way to know which group you’re in, But a biopsy report with multiple issues could say you are likely to have problems.

Doing a decipher test can tell you where your chance of reoccurrence is. Maybe give you some comfort if you come in real low.

Didn’t have decipher. My biopsy, RP pathology and sonomic testing were horrific enough. If I did have decipher it would’ve been over .99. I can only hope they radiate what’s left

The problem is there are so many people that I can’t keep track of each symptom. Your profile woke me, a decipher is unnecessary with your situation. Hopefully your treatments will work for long term.

@ozelli yes, i did get a second PSMA which confirmed the values.

I was diagnosed at 57. PSA was 6.9 and Gleason 4-3-7. Opted for RARP at Phoenix Mayo with Dr. Abdul-Mushin. At my age and potential for rising PSA I just wanted it out. Was a firefighter for 35 years so that was/is working against me. 6 weeks post op. No need for pads and bedroom was back to normal at 5 weeks post op. Dr. Abdul-Mushin is amazing.

I am new and completely ignorant. What is BCR?

Biochemical Recurrence - return of PSA levels above < .1 after prostatectomy or 2 points above lowest level achieved after radiation treatment (nadir)

Thank you!

No question: HAVE THE RADICAL PROSTATECTOMY. Gleason 8 and 9 is very serious. Your one advantage is your youth. You may recover faster and more thoroughly. But...go to THE BEST university/high-reputation medical school hospital where the best medicine is practiced. Don't turn yourself over to the local "best urology group you could find." And whatever you do, do not go to a Veteran's hospital...they are quite sadly, under par with quality of physicians and medicine...I have direct experience with them, having consulted to such hospitals for five years during my career. They mean well...nice, good people, but...they are run by the government, and the government does nothing well except spend and waste money.

Biochemical Recurrence (BCR) in Prostate Cancer
BCR refers to the detection of elevated prostate-specific antigen (PSA) levels after treatment for prostate cancer, indicating a possible recurrence of the disease.
Definition and Incidence:
BCR is typically defined as two consecutive PSA values ≥0.2 ng/mL after radical prostatectomy (RP) or ≥2 ng/mL after radiation therapy (RT).
The incidence of BCR varies depending on factors such as age, Gleason score, and treatment modality.
After RP, the 5-year BCR rate is around 20-40%, while after RT it is around 10-30%.
Risk Factors:
Higher Gleason score, Positive lymph nodes, Younger age, Higher PSA levels at diagnosis, and Rapid PSA rise after treatment.