Diagnosed today w/ PCa. Seeking feedback w/ treatment I think I want

Just wanted to respond to one part of your post, usually the 5/10/15 post treatment years refers to a BCR (biochemical recurrence) of cancer. For example, if someone has surgery then PSA should be "undetectable" and if PSA is no longer undetectable then that is considered BCR. It does not mean that cancer has necessarily returned, it surely does not mean it has spread, it just means the PSA number has risen above a threshold. Odds of BCR are calculated in like 1/5/10/15 years. Then sometimes 5/10/15 refers to life expectancy, but PCa usually grows so slowly that when relatively mild cases (like yours apparently) are caught early (like yours) and treated then life expectancy is not shortened by PCa (long way of saying a mild treated case of PCa isn't going to kill someone in 5/10/15 years).

You are going through correct steps and you will get good advice here. Probably will want to have a decipher test on the biopsy tissue, see how aggressive the tumors are. You will probably want to get genetic testing of your dna, to see if you have any mutations that make cancers likely. Might want to consider a 2nd opinion from a National Cancer Institute Center of Excellence.

I was about your age when I was diagnosed, went on Active Surveillance for a few years, got an MRI then a year later a 2nd MRI and another biopsy. At that point I chose treatment and for me I selected surgery. It's a big decision but keep researching and best wishes!

There are potentially other options. I did Tulsa Pro for my 4+3 and a 45cc prostate. I liked the technology and the low risk of side effects. No long term data on success yet, but 3 year data looks similar to surgery & radiation. I am at 2 years and no sign of cancer.

I opted for surgery, because I liked the precision of the procedure. At my then age of 75 & a Gleason score of 9, I thought non-nerve sparing was called for. However, many men have nerve-sparing surgery & it works for them.

I never had any incontinence.

Pick a surgery center associated with cancer research & with experienced oncologists, surgeons, & radiologists.

Did you ask the surgeon if they can spare the nerves if they do surgery? That can get you The ability to get an erection after surgery. If not, you can get an implant and they are very well liked by people that have gotten them, almost 90% satisfaction . You may have incontinence problems you may not, I didn’t have any incontinence after surgery but only about 10% of people have that. Most people can get continents after time, Sometimes it’s quicker than others.

If you get radiation, you have to realize that they do radiate the nerves. Over time that can result in not been able to get an erection. Doesn’t happen right away. Over time some people do become incontinent, but it is not as common as with surgery. I had surgery and it came back so I had radiation, Six years after radiation I started having incontinence. It’s been six years since and It has gotten worse over Time. I am 12 years past having 40 sessions of radiation and that’s the only problem I’ve had. Just today somebody posted about having proton radiation 15 years ago and now they’re having pretty continuous bleeding problems when peeing, Including clots, Because of damage to the Bladder. Here’s a link to that Discussion.
https://connect.mayoclinic.org/comment/1547497/
If you have SBRT radiation, Five sessions take care of it. It is very successful. You’re pretty young, so radiation may not be the best bet long-term. Something you need to discuss with your doctors.

Focal therapy might make sense for you. Something like that TulsaPRO That has already been mentioned by @jcf58 . That leaves the possibility of surgery or radiation later. When it’s only T2,a part of the Prostate is still there After focal therapy. Being able to get an erection and not having incontinence are pretty common.

You have to realize that the people that come to this forum usually have problems or our brand new. There’s a high percentage of people that never have recurrence.

You want to get a decipher score, as @jeff1963 mentions, so you can find out what the chance of recurrence is.

I’m enclosing a slide from a talk about Problems that happened due to radiation.

@jeffmarc Thank you Jeff (and everyone) for your responses thus far. I read the discussion on radiation and bladder damage. Feels like in some cases going the route of radiation is kicking the proverbial can down the road relative to post treatment side effects.

Per my Urologist, I will be scheduled for a PET scan then meeting with oncology radiologist followed by surgeon so I will get more input. Because I am super active, travel etc. I really need to nail the post treatment side effects component.

Thanks again, everyone.

When I faced that choice at 67, my docs said that I was on the border age-wise. Younger and they would recommend surgery. Older, and radiation was preferred. That was the opposite of what I expected. There are side effects for both treatments. I chose surgery, because I wanted that cancer out, ASAP. No regrets. Yes there are side effects.

@marlon

Did you have nerve sparing surgery and what was your gleason score.
Thank you

Ray

@marlon Thank you for your response. In all honesty, I have been banging the keyboard on my computer this evening with a vengeance. The more I look into this thing, the more I start to warm up to removal. But the whole catheter thing is not appealing but I guess I would need to deal with it. Hearing that you have no regrets is helpful so thank you.

@thig350

I was older than you, 69, when I had five sessions of MRI guided SBRT completed in 2023. My PSA was 10.2 with a gleason 3+4. I had no ADT. As of today, no new symptoms. Erections are a little softer. Urine flow is better than good. I try and listen to my bladder to go to the bathroom relatively quickly when I get the urge but so far so good.

You might want to do a telehealth second opinion with a center of excellence.

I saw your comment about testicle removal and I dont believe that is an option with any of the treatments. ADT as I understand sort of chemically castrates you but it will come back. Also as Jeff pointed out in either case, most everyone on here is following due to a problem. I opted for nerve sparring removal at a healthy 68. If I would have followed my oncologist advice I believe I would have been continent and no ED. The surgery and catheter are nothing to worry about. You have 3 small holes in your abdomen and the catheter is in for a week. They remove it in the Dr office. 2-3 weeks your wanting to do more than you should. They will remove the lymph glands and seminal vesicles. You will not have any fluid with an orgasm.