I have watched this forum for a while but have never posted anything. So here goes. I am 63 years old now. My biopsy was 3+4=7 Gleason and PSA was 5.2 at diagnosis. In my case, I chose nerve-sparing robotic surgery over radiation when I had my initial treatment in 2018 and my PSA was < .1 for four years.
I did this because my Dad was treated with radiation for throat cancer years ago and when it came back, they said surgery was no longer an option. He died six months later after lots of chemo. The other factor for me was that surgery provided a clean benchmark for success: PSA should drop to near zero. Radiation meant a drop to some “nadir” and then they watch it from there. After surgery, other treatments - radiation, PET scans, and ADT - these are all still on the table as future options to control a recurrence.
I just completed radiation last fall after a biochemical recurrence when my PSA climbed back to .23 over 6-plus years. Now, 6 months later, it is thankfully down to .04 after dropping to .07 after 33 treatments and 6 months of Orgovyx (the pill form of ADT.)
I meet with my radiation oncologist on Monday. I had a Decipher score done at recurrence - not at original diagnosis - and it was in the high risk range. Although I wish I had known that at the beginning, I would have done exactly the same thing. At age 56 when I had surgery - relatively young in prostate treatment terms - I regained urinary and sexual function within a few months. The reason I got checked for my PSA since my 30s was that my Dad got prostate cancer around age 70 and got the “seeds” therapy. He didn’t die of prostate cancer but his experience shaped my choices. My urologist and I always agree that our goal is that I die from something else - maybe with, but NOT of, prostate cancer. There are so many new and emerging treatments that are very encouraging. But I know it is my job to stay active and focused on my treatment so I can have those extra years with my family and friends. The job and the hobbies and the vacations won’t be there if I’m not there. I also remember good advice from my high school teacher: “Don’t worry about making the right choice: make a choice and then make it right.”