Question on delaying RARP surgery by 1 month

With a 3+4 you could easily go three or four months without doing surgery. Ask your doctors to delay it. An extreme thing you could do would be to go on ADT to prevent from spreading but with a 3+4 it’s not going to Spread or grow very fast. Even waiting six months would probably be no big deal.

I would say not a problem. I delayed for two months while daughter home during summer from college. We dropped her back at school on a Sunday and went into surgery on Thursday.

I wouldn’t give it a 2nd thought.

Delay surgery and enjoy the summer and the wedding.

I have the same 3+4 biopsy results. I am delaying surgery until September to be able to enjoy the summer. Surgeon had no issue and thought it was a good decision.

If you haven’t started daily Cialis, get your Doctor to prescribe daily cialis and viagra as needed. Someone else recommended starting before surgery to enjoy the benefits before surgery and prepare area for post-surgery recovery.

Best wishes

I was diagnosed with 4+4 in August 2022, scheduled for RARP in November but came down with the flu 2 days before surgery. I was rescheduled for the end of January and pathology was downgraded to 4+3. No lymph node involvement and have had no additional treatment. PSA remains undetectable @ 3+ years out

Jeff Marchi is probably right, but I’ll give my history as an “against the odds” example.

March 2014 - PSA rises to 4.5

April 2104 - Biopsy reveals adenocarcinona in right lateral apex, 10% involvement, Gleason 3+3. Active Surveillance recommended.

September 2014 - PSA rises to 5.2

January 2015 - I seek a second opinion, followed by another biopsy. Adenocarcinoma found in Right Apex with Gleason 3+3. Cancer in Right Lateral Apex is upgraded to 3+4. I opt for RARP, but delay until April because of three weeks of overseas work in March. My urologist had no issue with that.

April 2015 - Successful RARP. Pathology reconfirms Gleason 3+4 in Right Lateral Apex, and shows positive margin on Right Apex (Gleason 3+3). Prolaris score gives 53% chance of biochemical recurrence in ten years. My urologist states that it’s a good thing we didn’t delay further and says in hindsight, he wishes we operated sooner.

June-July 2025 - After ten years of undetectable PSA (<0.1), my PSA rises to 0.11. A small nodule detected in my prostate bed in 2023 lights up like a Christmas tree on a PSMA PET scan. No evidence of distant mets. Am diagnosed with a local recurrence.

Fall 2025 - Eight weeks of IMRT to treat local recurrence.

May 2026 - Six months after finishing IMRT, my PSA is still 0.1. Now am doing monthly PSA testing.

What started off as a presumably low grade, indolent PCa has become a life long issue. I don’t spend much time looking back on decisions I’ve made, but moving quicker on my surgery may have saved me from this current relapse and further treatment.

You will be fine postponing. Dr Andrews also did my surgery. We originally were going to do it in May, 2025. We had a trip planned for August, 2025 to Europe. He suggested rather than skipping the trip or stressing about post surgery issues during travel, to just enjoy the summer months and travel. We did that and the surgery was performed at the end of September. You are in really good hands. That whole team is top notch!

@melvinw
I agree don’t spend much time looking back. A BCR in 10 years is very good. Certainly we all hope the cancer is gone for good but is not typically with Prostate cancer it can become more a chronic illness and not a death sentence. Today your initial biopsy from 2015 of one core of Gleason 3 (3+3) only 10% likely most Doctors would not want to treat and it would be AS today. Even today with your second biopsy of one additional Gleason 4 (3+4) favorable with the prolaris at 53% for 10 years recommendations would include AS.

You are great hope to all the patients that come out of surgery and advised that they have positive margin and become depressed and discouraged. It shows that long term remission can still occur. Having a life long issue, non Hodgkin’s lymphoma treated twice with chemotherapy then Prostate Cancer but being allowed to watch my daughter grow and and go to college when I never thought I would see that, I thank God for the chronic cancers that I got if I to have been so unlucky. You can count down all the different types of cancers every one gets and they are routinely gone in 6 months, one year, 18 months, 2 years and 3 years from their initial diagnosis.

I would delay and travel. There is no absolute right answer.

Best wishes.

I put off getting to the bottom of my rising PSA for months. I bought into what used to be a widespread belief that many primary care doctors still subscribe to which is PSA testing leads to so much unnecessary care it shouldn't even be performed on men over 70.

Following this advice is what had Biden's doctors not testing him until pain symptoms got them to diagnose stage IV prostate cancer already spread to the bone.

Anyway, when I did follow up, I got a diagnosis of grade group 3, cT3b, seminal vesicle invasion, no other evidence of metastases. Localized, "at least high risk". As I understand things, this type of case if the diagnosis is correct, is still treatable with curable intent, but because it borders on stage 4, delay in treatment seems not good at best.

I could have saved 4 or more months had I acted sooner. My treatment options would have been better if I was cT3a even.

Now that I've come a bit more up to speed on what is known about prostate cancer diagnosis, it seems to me that there is enough uncertainty in all of the tests that once you've decided on treatment, a guy should get that treatment as soon as possible.

Eg. studies comparing the biopsy result to what a pathologist finds once the prostate is analyzed in the lab after removal show that many biopsy results were incorrect. Gleason 6 is fairly often upgraded to 7, and 8s and 9s can be downgraded. The conclusion of one fairly recent study:

"In counseling men with clinically localized prostate cancer, the odds of GS change should be presented, and certain men with high volume GS 6 or low volume GS 8 managed as if they are GS 7".
https://pmc.ncbi.nlm.nih.gov/articles/PMC6859655/

On the other hand, if you are looking for solid evidence to support a decision to delay a bit, there are numerous papers that studied the effect of delayed treatment caused by the Covid epidemic.

Eg. this article and its references published in Urology Times: "Pandemic-induced delays in radical prostatectomy unlikely to cause adverse oncological outcomes"

"Compared with patients receiving RP within 3 months of diagnosis, patient undergoing surgery 4 to 12 months after diagnosis did not have increased odds of adverse pathology, upgrading on RP, or node-positive disease. The investigators hope their findings offer some reassurance to urologists and patients trying to balance medical decisions with safety precautions during the COVID-19 pandemic."
https://www.urologytimes.com/view/pandemic-induced-delays-in-radical-prostatectomy-unlikely-to-cause-adverse-oncological-outcomes