Deciding between radiation and prostatectomy

@ray092271
Six cores is at the point at which they recommend treatment be done. I assume none of these were 3+3.

The type of intraductal You have is not the aggressive kind, yet.

I would suspect your doctor’s going to recommend treatment soon.

@jeffmarc
One core was 3+3 Jeff.
Diagnosed 01/21/26 Dr Urologist/Surgeon suggested schedule 4 months from that date, Radiologist SBRT said same patient with exact same diagnosis she is comfortable with 6 months.

@ray092271
You say grade group 2 which is 3+4. How many of the cores were 3+4? We’re 5 of them, since you said 6 positive and one was 3+3.

By the way, my history.

2010 I was 62 and a biopsy showed Gleason 3+4. My father died of prostate cancer and he had radiation so I decided to have surgery. After surgery they told me it was a Gleason 4+3. It was only stage two. 3.5 Years later it came back, I had a Lupron shot 2 months before 8+ weeks of radiation. 2 1/2 years later it came back and I went on Lupron. I became castrate resistant 2.5 years later and added biclautamide. 1.25 years later went on Zytiga, which kept my PSA down for 2 1/2 years. After some AFIB Issues I switched over to Nubeqa. The last 28 months I’ve been undetectable. I became stage four about six years ago, had a metastasis on my spine zapped 3 years ago. I did not find out I was BRCA2 Until five years ago. That’s why it keeps coming back, I’ve had four reoccurrences.

.

Yes, 5 cores were 3+4, 1 core was 3+3, 2 cores were suspicious, and 5 cores were benign.Thank you for your history.Wishing you the very best!
Ray

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@ray092271
You say grade group 2 which is 3+4. How many of the cores were 3+4? We’re 5 of them, since you said 6 positive and one was 3+3.

By the way, my history.

2010 I was 62 and a biopsy showed Gleason 3+4. My father died of prostate cancer and he had radiation so I decided to have surgery. After surgery they told me it was a Gleason 4+3. It was only stage two. 3.5 Years later it came back, I had a Lupron shot 2 months before 8+ weeks of radiation. 2 1/2 years later it came back and I went on Lupron. I became castrate resistant 2.5 years later and added biclautamide. 1.25 years later went on Zytiga, which kept my PSA down for 2 1/2 years. After some AFIB Issues I switched over to Nubeqa. The last 28 months I’ve been undetectable. I became stage four about six years ago, had a metastasis on my spine zapped 3 years ago. I did not find out I was BRCA2 Until five years ago. That’s why it keeps coming back, I’ve had four reoccurrences.

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@ray092271 Hey Ray, it’s really a coin toss, sorry to say; but I will tell you this.
When I was diagnosed at age 64 with Gleason 4+3 in most of my prostate, I consulted two different RO’s who said they could treat me successfully.
I then went to a very well known NYC prostate surgeon.
After looking at my biopsy report (which wasn’t good) he sat back and said, “You know, if you were 10 years older, even I would recommend radiation; but you’re too young and there’s a good chance this could come back.”
I had surgery but my point is that even this surgeon - who had something like 4000 RARP procedures on his resume (also worked with pioneers of DaVinci system) - was recommending radiation IF I were 74 - your exact age.
Take that for what it’s worth but my diagnosis was far worse than yours and even the famous surgeon was advocating radiation for men in your age range. Best,
Phil

@heavyphil

Thank you Phil.
I feel like I am stuck at the moment between surgery and and radiation.
The pull to surgery has been "The Hood technique", my surgeon uses, a nerve sparing and he says that excellent continent results can be expected.
Then radiologist no cutting exact treatment with side effects possible later.
Still thinking. watched many PCRI.org
Thank you Phil and best to you!

@jeffmarc

Yes, 5 cores were 3+4, 1 core was 3+3, 2 cores were suspicious, and 5 cores were benign.
Decipher .46.
Thank you for your history.

Has anyone with PC ever asked their doctor/s what they would do if they were in the same boat?

@ray092271
With so many 3+4 cores I would be concerned that a prostatectomy would find more issues and a higher Gleason score in some spots. That happens to a lot of us. As I mentioned, mine was a 4+3 after the surgery, Too many people with 3+4 end up 4+5 after surgery.

I think I would prefer surgery If I were in your situation, It may find more things and it will keep your ED and incontinence problems to a minimum.

Getting radiation will definitely cause long-term ED issues, In a year or two.

Even with radiation, however the results in the long-term are usually very similar.

@ray092271 Surgical technique definitely matters; the Hood Technique and others which preserve structures in the space of Retzius all contribute to better urinary outcomes.
Even my surgeon 7 yrs ago explained that he “comes over the top” to help with continence, although he didn’t get too technical on the specifics.
At age 74 there is NO wrong choice - either procedure will be successful; No One can predict SE’s, no matter what! Surgery and radiation can both produce mild to severe side effects…or NONE.
The only test available to see how you stack up radiation wise is Prostox and it will give you an idea of whether or not you will suffer from more extreme problems.
The main reason for choosing surgery as primary treatment is being able to use radiation if recurrence occurs; the opposite is much more difficult.
So you need to address how you view your particular case and look into the future 😳 and imagine where you’ll be in 5 or 10 years time…easy, right? Best,
Phil