44yr PSA180 Gleason9 non-metastatic. Surgery or Treatment?

Posted by dinu @dinu, Aug 29, 2025

I am 44 yr old, Navy Veteran, just got diagnosed with prostate cancer. First rectal exam showed enlarged prostate, followed by PSA180. Biopsy showed 9 out of the 12 samples with cancer cells (most of them Gleason8 or 9). MRT shows no spread. CT with contrast shows no spread. I just got today my bone scintigraphy. Initial results show no spread. Father had prostate cancer last year, therapy, seems to be cured. Mother has breast cancer and stomach cancer (surgery and treatment) now cured.
My big question now: should i go for complete prostate removal or should i go with the various other treatments?
I am currently being seen for this at the University Clinic of Heidelberg in Germany.
Appreciate all the support and stay positive.

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robertov | @robertov | 4 days ago

I didn’t see whether you had a PSMA Pet scan. That *needs* to be done to ensure your cancer has not metastisized beyond the prostate. If it has surgery along won’t get you cured. You will need radiation therapy also and probably ADT. ADt will arrest the cancer progression until you decide. You have time!
I’m not a doctor but I understand surgery at your age, you should recover well.

Germany (as I’ve heard has very good PC doctors and approaches and are not under any monetary conflicts. Many travel to Germany for care. Remember that at your age, preservation of function is important.

dinu | @dinu | 4 days ago

In reply to @robertov "I didn’t see whether you had a PSMA Pet scan. That *needs* to be done to..." + (show)

@robertov I did have 2 PSMA scans. One in September and then another one in January.
During this period I was in ADT (Firmagon) monthly injection.
The ADT reduced the size of the prostate by 50%, and one of the lymph nodes was no longer visible on the second scan and another node shrank from 14mm to 8mm.
Thanks for the encouragements!