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@brianjarvis
Your experience mirrors mine except for the timeline. I was 62 when diagnosed - no health issues - very active (still). I was gleason 6 for 16 months with 4.1, 3.74, and 3.5. Three months later my annual physical blood work showed an increase in my psa to 4.04. I advised my urologists office and they sort of dismissed it and I asked to order a psa (I was 9 months out from a scheduled MRI). The PSA came back at 4.1, I asked for an MRI in January (6 months early) that came back pi-rads 4 (which the urologists office also thought was less urgent). I asked to move up my appointment and biopsy. When the actual urologist saw the results, he immediately scheduled a perineal biopsy (vs rectal) for better accuracy. The result showed cribriform in one tumor (new) and cribriform developed in an existing tumor (3+4). The progression occurred in about 16 months. I start radiation in the next 3 weeks (SBRT - 5 sessions at center of excellence).

Prostatectomy vs. SBRT offered no advantage per my urologist surgeon (Joseph Wagner - a star robotic surgeon with over 4k successful case and one of the pioneers in the application). He was very straight forward - your choice advised that if he were me he would be unable to determine a best option (he is known internationally as a Highly Regarded surgeon). Under his care I opted for SBRT with a MSK trained radiologist and 6 months ADT.

Prostatectomy is right for many patients. For me with localized cribriform and a curative option with radiation I was not willing to take the chance on lifelong/regular incontinence and ED. I expect a full recovery within 6 months and regular psa until I am toes up.

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Replies to "@brianjarvis Your experience mirrors mine except for the timeline. I was 62 when diagnosed - no..."

@jonathanack That’s the personal call that the urologist/oncologist can’t make. I don’t know too many diseases/illnesses/injuries where the first choice is to amputate.
For me, the treatment decision was a relatively easy (but time-consuming) choice. One of the understandings I had with my doctors was that quality-of-life and successful treatment were equal priority for me. That set the basis for us working together and agreeing on a treatment plan. So, with success rates comparing surgery with radiation being statistically equivalent no matter what treatment chosen, it all came down to side-effects and quality-of-life.
So, I put together a spreadsheet and listed across all treatment options. Then I listed down all possible & possibilities (%) of side-effects from each type of treatment, and gave each one a score. The one with the lowest total “score” ranked highest. We then took that list, and narrowed it down based on the preventions available related to each individual type of treatment.
I then “scored” the quality of life priorities that came out of my personal introspection, and compared that final score result with the treatment options score result. The score that was closest matching was my 1st choice: Proton ranked 1st —> then IMRT —> then SBRT —> and last was surgery.