Undecided Gleason Score 4+3=7 and PSA almost forty.

no you need to do something and soon. I dont know if ADT therapy with radiation in 3 months is an option- however, since your whole prostate is involved, it would prob be wise to remove..then have radiation...

at your age, with this scenario of Gleason score and area of prostate involvement, I dont believe waiting would be a good idea...in 6 months, your PSA could be wll over 100...and then you would be facing a much bigger problem...

you might get an opinion from jeff Marchi on this board..he is unofficial guru of PC treatment knowledge..or quickly schedule with another oncologist group that specialies in Prostate Cancer..take biopsy report, latest PSA ..dont linger ...you are far from hopeless..but 6 month delay will prob narrow options considerably.

Why do you think you’re still on the fence?
> Why did you make this treatment decision?
> What haven’t you considered yet?
> Were there other risk factors in the MRI or biopsy that led you to this decision?
> Are there tests that you haven’t had yet - biomarker or genetic or other - that would change your treatment decision one way or another?
> What is still missing that makes you still hesitant?

If you ask yourself those type questions - why/what/when/where/how - and have solid answers, you’ll be more confident in your decision.

You mentioned that “PSMA was clear except for one glad that showed some of the trace but they think it’s ok.”
> What was the SUVMax score they assigned to that suspicious area? (It should be in the scan report.)

If it were me, I wouldn’t just “do nothing”; but, at this point - the day before any procedure - I would have all those things figured out.

All of us have been in a similar situation and have had to work through this decision. (If you are actually thinking about doing radiation already, then why do both?) Be positive about whatever choice you make.

(At 65y, I had a 4+3=7, PSA=7.976, localized, and chose proton radiation + ADT. We spent many, many (many) months reviewing and evaluating every treatment option; my treatments were during April-May 2021. By the time we started treatment, I was completely confident that we had reviewed all the data, did all the soul-searching, and made the decision that was right for me; there is no way to be 100% certain.)

to me at 51, or really any age why would you do nothing. It took me about 30 seconds at the age of 68 to have it removed. six years now undetectable. I have 8 grandkids all born after the age of 51. Lifes not a bed of roses but......

Agreeing with @brianjarvis comments.

It is common for most patients to have anxiety before a prostatectomy.

You previously chose a prostatectomy as opposed to radiation therapy for a reason. Has that reason changed?

Thanks everyone for replying so fast! I have a great team of doctors and have done a lot of research. Surgery is the best option according to all the Drs considering the testing and being able to do radiotherapy afterwards. It is the anxiety of the possible side effects of the surgery and still the possibility of needing the hormone and radiation treatment down the road even after surgery. I know that is what needs to be done. Just still hesitant over going through it all. Didn’t know if anyone close to my same situation waited and how that road looks. (Which I think I already know that answer).

I do agree though that waiting will definitely narrow future options and that there’s no way to be 100% certain.

Thanks again! I really appreciate your comments!

@lastminuteundecided You’ve got a pretty good idea of what you are up against; and you know there’s a pretty good chance that you might need ADT/radiation at some point as well due to the lymphatic involvement. The real question is IF you need further treatment after surgery, will it be immediate (adjuvant) or down the road ( salvage)?
Your surgical pathology will give your team a very good idea of the aggressiveness of your cells. If you have certain characteristics, such as cribriform patterns/IDC, they may suggest therapy sooner rather than later.
My best advice: Hope for the best, plan for the worst… But in either case, treatment should be successful and you’ll be fine. Best,
Phil

@lastminuteundecided
I was 4+3 at age 64 and never considered doing nothing. You are 51 and need to go after it now and will be on this journey for the rest of your life. However, sounds like you caught it early enough that your future looks bright. Nobody wanted to join this club and it can be scary, but there is hope and optimism provided by this group of warriors. Best of luck.

I have accepted Salvage Radiation Treatment after RP as necessary and helpful to treat my PCa. And I certainly would choose treatment over no treatment.
Please take treatment one step at a time.
Reasonably similar path: I had RP for G 9 hoping to remove PCa and have a "cure".
Post-op confirmed G 9 and added EPE. My post-op PSA was a disappointing.19.
Had Salvage Radiation Treatment w/ ST ADT Orgovyx.
Now 2 1/2 yrs later I have had 9 consecutive undetectable uPSA tests < .02
Yes it was a hard course, but some men are undetectable after RP and some are not. I was not and I am hopeful that the Radiation cleaned up the escaped cells. If, or more likely when, my PCa returns. I will seek to treat it with the medications and protocols that exist or are developed.
RP was the correct choice for me, and Radiation is correct for others as a primary treatment.
We are fighting cancer and it is an insidious and evil enemy.
I hope that you find peace in your decisions and sincere best wishes.

I was G7 4+3 and chose SBRT and six months of ADT. 18 months later my PSA is undetectable even though my prostate it still there and I've been off Orgovyx for more than a year. My thinking was that modern radiation is very precise.

I was hesitant because of the "surgery after radiation" question and was told that, almost always, a recurrence after surgery OR radiation is treated the same way. That cemented my decision. For me it was -- why have side effects from both surgery and radiation? Radiation was easy--a couple months of tiredness and some burning urination. ADT was another story altogether but I'm improving slowwwwly but surely and have been switched to six month monitoring instead of three.

@scottbeammeup
I am puzzled by your response.

If you had SBRT radiation it has essentially destroyed your prostate. It’s no longer there it’s been melted into residual tissue. Yes, you could have an operation to remove that tissue but not many doctors do that.

If there’s a reoccurrence after surgery or radiation, the treatment is very different. If you have surgery, then you can have salvage radiation if it comes back. If you have radiation, you can’t have salvage radiation because you’ve already had a lifetime of radiation in that area. Yes, you can zap metastasis that pop up but for initial radiation treatments the usual treatment is drugs or in advanced cases,chemo or Pluvicto If there are a number of mets.