Decision time SBRT, IMRT or surgery

I have gotten myself so confused I am not sure which way is up at this point. I had pretty much decided on SBRT and then started researching Focal Therapy and asked the surgeon at Duke (which is where I went for 2nd opinion) and was told well you might be a candidate but would need a second biopsy and would I be interested. I asked why this wasn't brought up in our original meeting and if my insurance would cover this. He went radio silent with no response from that, I asked again about insurance and finally got a response from a nurse. The surgeon is away for a week or so and was told he should get back to me in a few days. It amazes me that a question like would this be covered under my insurance is something they should basically know.

I really don't like the sound of the side effects from any of the procedures and I have some other issues that I feel will cause a issue with surgery and since I own my own business its going to be hard to be away for that long.

@harvey33 The RO’s don’t really know insurance - especially with all the plans out there and worse, who administers them; there are different tiers as well…a nightmare indeed.
Focal therapy really requires very careful consideration by the team. It sounds like it would LESS involved, but it is not.
Where the lesion is, how big it is, what critical structures it’s close to - all these play into WHICH focal treatment might be best.
The second biopsy would probably be a larger sampling of the gland to be sure that you have no disease elsewhere ( or more). It would be foolish to focally treat the area(s) found on the first biopsy without treating the others.
Phil

@heavyphil
I understand about how screwed up our medical system is. My main point is I hate the lack of communication that I’m receiving. I also totally understand the 2nd biopsy but it appears to put the cart before the horse if my insurance plan isn’t going to cover anyway.

I have gotten myself so confused I am not sure which way is up at this point. I had pretty much decided on SBRT and then started researching Focal Therapy and asked the surgeon at Duke (which is where I went for 2nd opinion) and was told well you might be a candidate but would need a second biopsy and would I be interested. I asked why this wasn't brought up in our original meeting and if my insurance would cover this. He went radio silent with no response from that, I asked again about insurance and finally got a response from a nurse. The surgeon is away for a week or so and was told he should get back to me in a few days. It amazes me that a question like would this be covered under my insurance is something they should basically know.

I really don't like the sound of the side effects from any of the procedures and I have some other issues that I feel will cause a issue with surgery and since I own my own business its going to be hard to be away for that long.

@harvey33
I am just the friend and I am so confused. Just last night with a phone call from Stephen I have learned that that the radiation treatments are going to be 28 treatments with photon radiation instead of proton. I apologize I am still trying to learn all the acronym’s. He is not the best eater and the only exercise he does is walk. I am that friend that feels like that game show “phone a friend” he still is not ready to share and tell people except his sister which has gone with him to a couple of appointments.
He has more bloodwork tomorrow morning and treatments start next Monday.

@miggie
A lot of radiation oncologist will tell you that there is not a big difference between photon and proton results when you are talking about prostate cancer treatment.

A Mayo RO Who was at one of the monthly meetings Mayo has every month says he’s only used proton four times in all the time they’ve had the machine.

I was diagnosed similarly in Dec 2025 with Gleason 7 ( 4+3 ). In my case, I did not want to have ADT in conjunction with radiation. Side effects from ADT did not sound good “ to me”. Opted for nerve sparing surgery in consultation and encouragement from my wife. This was accomplished by a brilliant and kind surgeon in Jan 2026. My recovery has been superior. Thanks God🙏🏽! Almost 100 percent continent straight away. ED has been a challenge with penile rehab filling the gap. VED and tadalafil and kegels daily keeps it healthy. Recently Trimix use has been a complete game changer . Sex life is excellent and intimacy back on track. Natural return of erectile function also making huge progress. I am confident will get 100 percent return when nerves fully heal. Oh, and almost forgot, last PSA <.004. Praising God 🙏🏽🔥!!!!
It’s a challenging decision which is different for each individual. Communicate with loved ones providers and God! Hope your outcomes are as good as mine!

@tattodice Wow, you have a good story to hear as I am approaching the treatment decision which will happen in 2+ months after seeing the RT and Robotics Surgeon. Urologist is suggesting surgery. PSA 10.8-12 aver., T2, 6-3+4, and 1 core 3+3. <5% pattern 4, and <10% found in cores. I am 68 and keen to train prior to and post. I would very much like to track your story onward as I believe that it sounds like how I want mine to unfold...

@tattodice thanks for letting us know. Glad things are going well.

Who was your surgeon?