64 and recently diagnosed with prostate cancer, options?

@lwhines, did you have your follow-up appointment today? How did it go?

yes, I received the Decipher test which confirmed high risk. I uploaded it and am still planning on using Mayo clinic for my treatments as scheduled.
Thank you.

Update:
1/22/26 - Mayo visit: PSMA, radiology consult and surgery scheduled same day.
1/29/26 Follow up with local Urologist, Decipher test results confirmed high risk, unhappy with office/plan.
Mayo plan:
2/17 - PSMA Scan in morning followed by consult with Radiation oncologist in afternoon
3/19 - Surgery

Feels fast, but worried about delaying. From local urologist, he feels multiple modalities of treatment will be needed. I assume this will be topic of consult following Pet Scan. Thoughts?

@lwhines
It looks like you are doing detailed research and having ongoing discussions with your docs. I was in a similar situation last year, with a Gleason 10 diagnoses that was downgraded to 9 with cribriform after surgery pathology completed. I chose surgery due in part to the higher potential of needing future treatment options as well. It was a personal informed decision with docs and family. And it sounds like Mayo was your second opinion, which is always encouraged. My surgery was scheduled after the PSMA PET and fusion biopsy, but I had time to do more research. Surgery was scheduled to ensure that I locked in Doc’s time, as well as that of the Da Vinci surgery site. I don't regret my path and would choose the same again. I am almost 4 months past RARP and I do have the post-surgery issues some experience - light incontinence, ED - but improving as time goes by. Keep discussions going. Some questioning is good, it drives education. Best to you and yours.

@lwhines With a high Decipher score, multiple modalities ARE often needed.
As @rlpostrp has said, only a surgical pathology (and perhaps further testing of those aggressive cells) can show what is really going on with your cancer; types of cells throughout the gland ( those missed by biopsy), extent of disease into surrounding structures and lymph node invasion.
Those factors are then used to either determine a wait and see approach using 3 month PSA tests or comprehensive Adjuvant therapy which calls for being placed on ADT after surgery followed by radiation.
You have a lot of ifs and maybes on your plate so forget about them for now. Your first step is surgery and it could, in fact, be your last! So just hope for the best, plan for the worst and like so many of us you will be fine.
Good Luck!
Phil

Thanks for info and encouragement. I'll keep educating myself.

PSMA Pet Scan showed cancer contained to prostate with possible seminal vesicle invasion on R side. No lymph node or other foci to suggest metastatic spread which was good news. It was interesting that consult with radiation oncologist afterward leaned toward continuing with the surgery plan. No real discussion of radiation or other treatments post-surgery, maybe too soon.

So, for now, trying to prep mind/body for RARP 3/19. Looking for any/all continued tips to address catheter/bag, car ride home (2 .5hrs), sleep, etc. as well as addressing the post-surgery incontinence issue. Currently purchased the Dayeek tearaway pants and am looking for the appropriate PT therapist, Thanks for all the encouragement and support. It is really good to read about other people in similar situations.

@lwhines
They usually let you out of the hospital the day after surgery. At that point, I found that sitting in a seat in my car was just extremely uncomfortable. Being able to lay down in the back really helped on the 1 Hour drive getting home. Have whoever you are driving with bring blankets, maybe pillows that you can rest on. Something thick enough so laying down was more comfortable. If you can stay one more day, it can make a big difference. I was 62 when I had the prostatectomy.

I found that starting the Third day after surgery all I needed for the pain was acetaminophen. I had the catheter for two weeks, Really convenient not to have to go to the bathroom to pee. Hand to empty the bag every few hours, But not too frequently.

I had no problem sleeping after the surgery. I actually went to three clients offices and worked on their computers on the fourth day after surgery. On the seventh day after surgery, I started working full-time again. Took it easy and didn’t lift anything heavy.

You never know what incontinence is gonna be like after they take out the catheter. I had none at all. Some people have a little and some people have no control at all.. Don’t buy too much stuff ahead of time you may not need it and you can always have somebody go out and get you more.

@lwhines, once I was home, I used a new 5 gallon bucket beside the bed to keep the catheter bag in while I slept. This would prevent a mess in case I didn't clamp in correctly after draining. It also was good for carrying the bag in when I did my frequent walks around the yard. I kept sanitizing wipes and alcohol pads nearby and frequently wiped down the tubing. I didn't want to get a UTI and have to wear that catheter any longer than the 7 days. I didn't change to the small bag until just before walking into the office for removal, It was hidden under some baggy shorts. I took a stool softener daily and didn't have any issues with my first BM. That part was tricky just take your time. Before surgery I hit the kegals hard every other day. I did them while walking, moving around, and pretty much all day, then let the muscles recover the next day. Text me if any questions or if there's anything I can do. My wife and I were just there earlier in the week. I'm blessed to still be < .1 after 29 months. Praying for your successful treatment in March

Thaks for the replies!