Would you recommend proton therapy vs surgical removal of prostate?

I had HIFU done 7+ years ago. It worked for me. Luckily, I’m close to one of the few locations on the East Coast that does that. Minimally invasive.

I had HIFU done 7+ years ago. I recommend that over surgery or protein treatment. The cancer has to be localized to the prostate. No problems since or before, as a matter of fact.
My best for a good remedy.

https://www.urotoday.com/conference-highlights/eau-annual-congress-2023/eau-2023-prostate-cancer/143058-eau-2023-15-year-update-protect-trial-part-i-oncology-jenny-donovan.html
https://scienceinsights.org/what-the-protect-trial-reveals-about-prostate-cancer/
https://pubmed.ncbi.nlm.nih.gov/36912538/
Given your age and Gleason score I would just monitor. Research the Protect T trial and others

@seekingclarity thanks for this post and the great questions. I will be following this thread as I am in a very similar situation, but a few months behind you. I had my first biopsy on 12/2 and it showed two G6's and one G7 (3+4). I am still waiting on my decipher results. I'm 57 and am going to take the next several months to research my options (surgery & if so where, tulsa pro, ongoing active surveillance, etc.), unless the decipher results indicate something potentially more aggressive than the "favorable intermediate risk" the dr. believes I currently have. To your question about PSA results, like the others have said, I think they consider it more of an indicator and not necessarily anything definitive. Also, it is quick, easy, and cheap, so it makes sense that the doctors would start with PSA. After several elevated PSA readings and a negative MRI a few years ago, my dr. recommended Iso PSA, which ended up being unusually high. From there we went to an MRI which was pirads 4, and most recently a biopsy with the results above. I think this is a fairly normal progression, even though I'm on the younger side. The one redeeming fact about prostate cancer is that it's fairly common and also usually slow growing. There's a lot of data out there, and most of us have time to weigh options and make decisions.

At your age, I would research all the alternatives that are not FDA approved, including the proton therapy. My situation at 67 was two lesions and a Gleason of 3/4=7. I was told I had 3-6 months to make a decision on treatment which gave me ample time to research thru hospitals here in TX (4 urologists) and one alternative doctor on the east coast in FL who was very helpful. Due to a hip replacement 20 years ago, my MRI was limited on a lesion on my right side. They need a good MRI as they use this as a map when they attack the specific cancer in the prostate with whatever treatment they use to eradicate the cancer. Due to this fact, I was told by all the doctors that I was not a good candidate for the other alternative treatments, including a doc at MD Anderson in Houston who preformed robotic and HIFU. I asked a lot of questions about surveillance, follow up after alternative treatment (prostate is still there which produced the cancer), and recovery, The good news about my robotic surgery is 15 months later, all is back to normal (yes, all the bad stuff you read about) and all 6 PSA tests have been 0. So, due to the prostatectomy, the prostate that was generating the cancer is gone. Good luck, you have options.

As far as I understand, urologists tend to all be surgeons. They tend to discuss surgical options. However the two urologists I saw made sure that I would see a radiation oncologist (RO) for a second opinion. Your doc may not have suggested getting an RO to give you a second opinion because your case is less advanced than mine. But, if you are getting interested in some form of radiation therapy as an alternative to surgery, see an RO. Ask your urologist to refer you, or just book an appointment yourself.

Every doc is going to have an opinion, and it surprised me how variable these seem to be.

Check this: Proton therapy is heavily promoted in the Pacific NorthWest - you can't follow the Seahawks football team without hearing about how great proton therapy is for prostate cancer. That proton place is in Seattle. I saw an RO there. He thought the institute should stop advertising protons, as the prostate cancer dept there was pretty unified that it isn't the best option compared to photon. Weird.

Surgery on a radiated prostate is a more difficult operation, I've heard, with more frequent severe side effects. On the other hand, I have heard an interview with a doc who has done 500 of such surgeries, but it seems to be a highly skilled thing most docs don't want to touch.

@seekingclarity
I (61 yo, 3+4=7) too was not sitting well with 2 different urologists recommending removal as best option, I sought an option from a oncology radiologist at Mayo. She would have gladly done SRBT if I wanted it. When talking to her team...the P.A. is male and if he were in my shoes, he would have had a R.P. . My decision came down to not waiting months to years to know if cancer free. I wanted to get rid of the cancer! In the Dr Walsh book, it talks about R.P. as being the gold standard for 100% cure. I had my robotic assisted radical prostatectomy last Wed. Pathology showed progression from 15% of sample as Gleason 4 in June to 70-80% 4s. in Dec When your time comes, RP is a great option that has advanced far beyond the earlier days.

@gfeaglefan

Gold standard for 100% cure.
I think not! I have had most of it - not chemo (yet) RP 12 years ago - recurrence then 39 salvage radiation, metastasis recurrence with SBRT, metastasis recurrence with SBRT, PSA this afternoon.

I have no false hopes for being cured

@gfeaglefan I was gleason 3+3. Decided on LARP. Only because I thought it gave me the best chance to be rid of it and I could always have other treatments. Its been 6 years with < .01 PSA. My feeling is I can never call myself cured. I have the PSA done now every 6 months but not going to get over confident.

I believe the 10 year remission free re-occurrence for either radical prostatectomy (RP) or external beam radiotherapy (EBRT) is 50%. This does not mean lethality as there are treatments. Moreover there will be advances, possibly curative in that period of time. Nonetheless the best form of radiotherapy, i.e, optimal dose without the side effect footprint is 'Low dose' interstitial radiotherapy [aka 'seeds). It provides the highest safe dose over time [weeks to months]. EBRT convenes multiple rays inside the prostate from outside but any higher would injure the surrounding tissue. In fact the EBRT providers use, interstitial radiotherapy boost ('seeds') afterwards. It does seem curious that the sequence is the optimal dose ($) last and suboptimal dose ($$$) first. Go to the You-Tube videos on the subjects produced by the PCRI.org.