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

While your initial Gleason score is 4+3 the rise in PSA you are experiencing makes it look like you may have a higher Gleason score. In my case at 62 I was a 3+4 before surgery and a 4+3 after, when they examined my prostate after surgery. I know a lot of people who ended up having Gleason nine after surgery because they only get 1% of the prostate when they do a biopsy. Your fast rising PSA could result in the same thing. If you don’t have surgery, then you won’t find out what your real Gleason score really is. You could have radiation, Long-term the success rates are the same, Surgery is preferred by many when having prostate cancer so young? It gives you the chance of having radiation after surgery if your PSA starts to rise again.

Has your doctor talked about nerve sparing Surgery. That would be very important for somebody your age. That way, you can probably get an erection after you have surgery, Maybe not right away, but within a matter of months.

I got prostate cancer at 62 and my brother got in at 77. Turns out I Had a genetic problem, BRCA2, Which causes the cancer to be more aggressive and to come on when you are younger. My brother didn’t have it, but our father died of prostate cancer and that increases the chance of getting it by about 100%.

You could get genetic testing to find out if it could be a factor. Does anybody else in your family have cancer? You can get it here for free, takes 2 to 3 weeks to get the results and a genetic counselor will call you. They will send you a kit that you return in the mail. You have to live in the USA to get this test for free.

Prostatecancerpromise.org

Don’t check the box that you want to have your doctor involved or it will greatly delay the test.

Yes at 51 with 4+3 the smart thing is to remove it. I am 73 with just evaluated at 3+4 with one core at 4 and PSA of 9.7. I am still on AS as it is localized deep in the prostate and no aggressive cells found to this point. My next PSA test will tell me if I need to take action. Some of the higher PSA at ages over 70 are due to the prostate getting larger so unless it doubles in a short time frame, I am comfortable where I am. When I need to act it will be proton radiation of SBRT with the MRi guidance depending upon the recommendations of the radiologists.

I can’t thank you all enough for your comments and advice. I’ve been following the group since I found out about 45 days ago. Last night I finally posted the question as my surgery is tomorrow morning. I wish I would have reached out earlier. You have all be great and Thanks again!!!! Wish the best for you all!!!! Stay positive!!

That’s quite a bit of volume so you should be thinking about what are the chances of you needing radiation too.

Others will have differing opinions but my thinking might be, why not just do radiation now instead of having all the side effects of surgery only to have to deal with radiation as well in the future.

FWIW I also was 4+3 (though I only had 4 out of 12 cores positive) and with a PSA of 17.5. No ADT and two years out from proton beam therapy am now at a PSA of 0.38.

Tough decision for you but whatever you chose will be the right one. Making the decision itself is much harder than the actual treatment. Wish you the best.

@jeffmarc The way my oncologist explained it to me is that if it comes back after radiation treatment it almost never comes back in the prostate so the second line treatment is the same regardless of whether the initial treatment was surgery or radiation--ADT and maybe chemo. Another factor was I'd already had two abdominal surgeries and didn't want to take chances with a third.

@scottbeammeup I was under impression radiation caused prostate cancer cell to die but sone functioning prostate cells remained. I was concerned cancer could develop in any residual prostate cells.

I was diagnosed at age 73 and, due to some previous abdominal surgery, chose radiation and hormone therapy. My PSA was 6.4 and the evaluation was Gleason 7, like yours. My radiation oncologist said frankly that, left untreated, this cancer would shorten my expected lifespan. With radiation and hormone therapy, my PSA has been "undetectable" (< .01) since May. Prostate cancer is rarely gone "forever," but if treated appropriately when diagnosed early it is virtually always treatable and manageable so as not ever to be the cause of death. Best wishes on your journey!

@scottbeammeup
If it comes back after surgery, there usually isn’t spread found anywhere else with a PSMA pet scan. The prostate bed is the most likely place for reoccurrence so that is why they do salvage radiation for almost all cases of reoccurrence after surgery.

That’s what happened to me and I know many other people that have had the same treatment.

If you’ve had SBRT radiation you can’t really have salvage radiation because the prostate bed has already been radiated the maximum amount. Yes, if they do find spread somewhere else you can use SBRT on it just like for surgery patients.

It sounds like your doctor didn’t really explain clearly what the difference is.

Hi. I am 67 and had surgery in August for Gleason 8 which turned out to be Gleason 4 & 3 but also with cribiform and IDC. They could see one of my nerves was impacted so we agreed in advance that it would be removed along with the prostate. Due to that I cannot get erections. I wanted to stay alive and I am so glad it is out. Do not underestimate 4 & 3. This is not going to get better, only worse. I had urinary leakage for about three months after surgery and now am good. I was considered young at 66, and you are obviously very young for this situation. It sounds like you are dealing with anxiety and denial. That is natural. I was also advised that being younger the surgery was preferred and that there may be urinary leakage and/or erection problems. However, the radiation raises those same problems in the long term, so for younger people you can avoid delayed radiation effects.......Anyway, my 2 cents. Yes, this situation sucks but ignoring it guarantees progression and a worse situation. Both radiation and surgery are good options. Doing nothing is asking for a shortened life. They also say that they advise taking action within a year of diagnosis. The thing is that is based on statistical averages and in reality each day we go without treatment increases the risk of metastasis.

I’m writing this from my recover room. I decided to go through with the surgery yesterday. I have to say your support helped tremendously!!

I’ll give you a quick rundown on my decision. First, your support helped a lot considering I was on the fence the other night!!! I do have a great team of doctors and talked to many from different facilities who are all well known in the prostrate world. Two of the surgeons I spoke with used the Da Vinci Xi. Both said because of my previous abdominal surgery and large scar they were worried about the internal scaring or what they may find in there which may cause them pull out while in surgery. One of them mentioned that I may be a better candidate for radiation because of that. The other surgeon would be amazing although also had a little concern about the current abdominal scar, but thought it was worth a shot.

So then I started leaning towards radiation because I was still hesitant that whoever I chose may still not be able to through my abdominal area. The radiation oncologist I would have chosen if I went the radiation route is great and has a new proton machine that we would have used. I felt very good with him but he even mentioned at my age to go surgery first, that way we can still go back with radiation if any of the cancer shows back up. So it leaves the radiation option open if needed down the road, which I’m guessing it will be needed at some point.

My urologist or let’s say my quarterback through this journey and who has been amazing, recommend I meet with another well known surgeon who uses the Da Vinci SP. This option may be best in my situation because of the single point entry where he would not be needing to go through my abdominal area. In the end there is no way that I can be certain this is the best option without a crystal ball but it’s the option I ended up choosing.

Still though after all of my research I was still on the fence the other night about doing anything because of all the possible side effects and need for possible future treatments even after surgery, but hearing from you all helped me off that fence.

My kiddos, my wife and myself will always be grateful for your help! I cannot Thank you enough!!