When you mention a “negative PSMA PET” scan, did anything light up at all?

“Watchful Waiting” and “Active Surveillance” are two different protocols.
> Watchful Waiting: https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/watchful-waiting-for-prostate-cancer

> Active Surveillance: https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/active-surveillance-for-prostate-cancer

If you want to know whether or not ADT is necessary, get the ArteraAI prostate test. ArteraAI assesses your biopsy tissue to predict whether you will benefit from hormone therapy and estimate long-term outcomes.

> With your 4+3=7, what % of that was “4”?

My oldest brother (80y) is currently going through treatment for Grade Group 3 prostate cancer, Gleason 4+3=7. He already completed 28 fractions of IMRT (photon) and is halfway through two years of ADT (due to suspected spread to lymph nodes).

During April-May 2021, for a Grade Group 3 prostate cancer, Gleason 4+3=7, at 65y I had 28 fractions of proton radiation + SpaceOAR Vue injected + 6 months (two 3-month injections) of ADT.

I had no serious side/after-effects from the proton radiation: no GU, GI, rectal, or ED issues. The ADT did result in muscle atrophy (& 33% loss of strength), complete loss of libido (but no ED), and mild warm flashes. Those recovered once the ADT left my system & testosterone levels returned. (A robust resistance-training exercise program helped minimize ADT side/after-effects.)

(I considered brachytherapy. But, 3 guys I knew (high school classmates) all had serious urinary and ED issues with that treatment. (They told me that other guys they knew had similar outcomes.) So, I ruled that out early on. That was back in 2019.)

You can have both quality and quantity. It depends on the treatment decisions you make.

I made it clear to my medical team that successful treatment and quality of life were equal priorities for me. (These priorities are not mutuality exclusive.) That laid the foundation for open and clear discussions and coming up with a game plan that suited my personal goals.

I’m still active - lift weights 2-3 times per week; go on long walks with my wife; travel often; swim regularly (I’ve swam 84 miles so far this year; goal was to swim 100 miles; I’ll clearly make that). My relationship with my wife is good. Some time after treatments were over she told me that if she hadn’t known I was undergoing radiation treatments, she wouldn’t have realized it from any change in me. (That’s how benign this process can be.)

I spend a ton of time with my young grandkids. Life couldn’t be better.

This will work out well for you.