47 years old with newly diagnosed Gleason 7 (4+3)

I was 41 when I was diagnosed with PCa and the first path taken was to educate myself on the options and within that process was to have consultations with various doctors and self-education. When you start this journey, the doctors know more than you. The journey on this first path will come to a close when you know more than the doctors, from the point of view of your particular situation, and you will have the best option for you (surgery, radiation, etc...) Then the next step is to find the doctor that aligns with your bedside manner. At this point, you will be educated, you will have explored all options, you will have made an informed decision, and you will have selected the right professional to perform the action.

I'm 52 now and while I am dealing with a biochemical recurrence, I wouldn't change anything about how I went about dealing with this at age 41. The reality is that you could live for 50+ more years, so you need to pick the best option for lasting 50+ years.

I had RALP and was in good health and fortunate that the incontinence and impotence was a non-issue. Not everything is that fortunate, but if you are 41 and in good health, consider this the first and only chance you have for a CURATIVE solution.

be easy with yourself, you will make the right choice

I am currently 57 years old and was diagnosed with prostate cancer (Gleason Score 7 --> 4,3) in October, 2022. As with you, I am healthy and very active. I did a significant amount of research (online, talking with doctors, talking with others that had PC or knew of those that had PC, etc.). My research showed that given my age and life expectancy (25+ years), the radical prostatectomy was the clear choice. Radiation is obviously less invasive, but can reduce options going forward (if you have recurrent PC) and can cause other issues over the long term. Our medical tools are good but not perfect - I just did not want to bet my life on doctors being able to track the cancer going forward. Based on post-surgery pathology, my prostate cancer is most likely contained to the prostate (negative margins, seminal vesicles & 6 lymph nodes clear). However, I am a realist - This does not guarantee the cancer did not get out at some point, but does guarantee that the cancer cells that were in the prostate are now gone. Knowing this gives me a lot of confidence going forward.

As with everyone that has went through this decision, it is very personal and needs to align with your goals and expectations. For me, I am relatively "young" and wanted the identified cancer to be out of my body, with the lowest chance of recurrence.

I was initially at a local hospital in Iowa, but after doing my research, decided to go with Mayo-Rochester. The quality of life, for the rest of your life, will depend on the experience and expertise of your doctors. You do not want to be on or near the learning curve for your urologist/surgeon/radiologist/etc. Mayo-Rochester is one of the top ranked hospitals in the US. and has amazing doctors and support staff. I did research on what doctor to chose at Mayo and decided on Dr. Igor Frank. Dr. Frank is an amazing surgeon and has been doing radical prostatectomies for decades. He was also the second doctor to utilize robotic assisted surgeries in the US and has been doing them since 2006. Incontinence and impotence are risks, thus another reason to go with the best doctor possible (nerve sparing will be critical here). Because you are out of town, definitely would recommend staying in Rochester for a week. This will allow you to recover and get the catheter out prior to travel. If you are healthy, the surgery will not be that big of an issues. For me, the referred shoulder pain and catheter were the worst part of the overall experience. After the first week, the catheter is taken out and life goes on. Also, I was able to fully sit up after a week - Until this time, the referred gas pain was quite high.

Good luck with your decision,

Jim

Our conditions and age and treatment are similar. I am hoping for a cure but I suspect that the odds are against that. Best of luck to you and me and all the guys on this site.

This may be of help - https://www.urotoday.com/conference-highlights/aua-2023/aua-2023-prostate-cancer/144078-aua-2023-prostate-cancer-guidelines-where-i-see-progress-and-help-with-my-practice.html

Hammer. You research and thinking and plan of action are in my opinion very good. I wrote a post here that our situations were similar, but that was not in response to you as I am 76, Gleason 9 and my doctors are not optimistic for a cure. I do keep in mind Michael Millikan who had a prognosis of 2 years and that was 25 years ago and he is still active and doing very very good and he is my age. Best of luck.

Hello,
I had some similarities. Gleason 4+3; PSA double from 2.1 to 4.2 in one year. I went all over the map trying to figure what was my best option!
My wife and I discuss this at length. We both agreed I should go the RALP route, in January 2022. I purposely wanted to avoid radiation and hormone therapy because of the residual side effects. Now for our difference: I was 73 when I had my surgery. I’ve recovery pretty well, my energy level has allowed me to continue running marathons plus a podium place in last yea’s Bolder to Bolder 10K. I was incontinent for 10 months and am still impotent. My surgeon had to cut wide on wide side; so, the side effects were anticipated.

Keep on investigating your options. You’ll find what works for you.
Your Wyoming neighbor.

My opinion at your age I would think about the 5 day high dose radiation
treatment if confined to prostate. Still retain all male reproductive parts and less chance of impotence. Closely monitor results ,of course.

@tjmayo I believe you did Proton Therapy with a testosterone reducing drug. I’m 58 newly diagnosed 4-3s and 3-4s Gleason 7. Urologist is a radical prostate removal professional. I have read much on Proton and its benefits over photon. Without getting into all the other details, what has been your experience. Would you recommend. While I worry about the cancer, it’s the quality of life that seems to weigh on me more. Wearing diapers, incogotence, Ed. Etc. just wanted an opinion

@marshallfeller what did you wind up doing and are you ok so far with the results and your quality of life.

Covodoo, Many excellent responses to your question; I think it all comes down to your personality type. Are you a pessimist or an optimist?
For me, I ALWAYS want a Plan B…not sure if that makes me a pessimist, but this disease is sneaky and unpredictable…so maybe more of a pragmatist?
You are so damned young, have a family history of PCa and a fairly high Gleason score (I was also 4+3 at age 64). There is a good chance that your cancer may recur. Although surgery will have a profound impact on your life, it WILL give you a second chance to fight back with radiation should it fail.
And if you are indeed ‘cured’ - well so much the better. JMO as someone who needed that second chance - and who might even need a third. Best,
Phil