I was still working when I was first diagnosed, and then had a RARP in 2015 (age 62). My employer had a generous medical leave policy and I didn’t return to work for about four weeks, although I did some emailing and paperwork from home when I was up for it. My primary focus was recovery though. Even the first week back to the office was just a few hours per day, and I built up to 8-hour days over a of couple of weeks. My stamina came back gradually and steadily. The biggest challenge was urinary continence. For a few months, I was going through several pads a day. I even kept a spare pair of pants at work for accidents (and they happened a couple of times). It was definitely a process, and that process was made easier by the medical leave policy of my employer (I never went on disability). I was laid off a little more than a year later and continued working as a consultant until the pandemic hit. It was intermittent work, but also required some travel, including international travel. The urinary continence issue was annoying at times. I was down to one or two pads per day, but stress would make it worse. I finally retired fully in 2020. In 2023, I finally had a urethral sling surgery (outpatient) that my urologist put on the table years earlier. That procedure returned me to 100% continence immediately. It was a real game changer for QoL.

If you can successfully navigate the health insurance landscape until you reach Medicare age, and you are in good shape, treating the cancer when you are in good health and late 50s is something to consider. I am 73 now and am in pretty good physical shape and remain physically active, but the ravages of aging just keep presenting new challenges—joint replacement, hernia surgery, hearing loss, etc, etc. Same with my wife.

I just finished eight weeks of radiation therapy for a local recurrence on November 18. So far the only notable side effect has been fatigue, which I almost over now. But I can tell that the whole process was more taxing than it would have been ten years ago, even though I am retired.

Btw, I was also diagnosed in early 2015 with Gleason 3+4, and 3 of 12 cores positive. I was a candidate for treatment, but my urologist didn’t convey a sense of urgency. So the surgery was scheduled for a couple months later when it fit with my work schedule. But, the post-surgery pathology also showed that I had a positive margin, and the Prolaris test gave me a 53% chance of a biochemical recurrence in ten years. My urologist’s response to that data was, “We didn’t act any too soon, and we need to keep a close eye now”. He offered adjuvant radiation at the time, but we agreed to just watch my PSA. It remained undetectable for ten years and DREs came out fine, so no further therapy. And then lo, this past June, my PSA rose to 0.1, and I had a palpable lump in my prostate bed that lit up like crazy on a PSMA PET scan. Salvage radiation (IMRT) was the next step.

But yes, it sounds like you have some breathing room for making a decision as how and when to proceed. Best wishes.

Mel