mikeg73 @mikeg73

Lots of really solid advice from a bunch of guys who know way more than me. I'll share a little of my decision process below.

First up is my PSA journey; I went from 1.72 eight years ago up to 4.3 last October and now post surgery, I am below <.064 , which is a huge relief.

• 4/22/18 1.72
• 11/5/21 2.43
• 2/26/25 2.96
• 5/20/25 3.07
• 10/17/25 4.3
• 5/18/2026: <0.064

Last October, I was in denial, but with my increasing PSA trend, my PCP sent me to a urologist. The urologist said they could keep on doing PSAs every six months since my PSA wasn't that high or do a MRI. I was like, do the MRI!. My thought was that I could just eliminate the whole issue and not have to worry about it.

Turns out , post MRI , then biopsy and a follow-up PSMA-PET SCAN, I was 3+4=7 prostate cancer.

I explored surgery and radiation. I took a Decipher test (typically done by the radiologist if you are considering radiation), which showed my cancer was moderately aggressive, which meant he recommended hormone therapy on top of the radiation for six months I really did NOT want hormone therapy as a first course of action.

I went with the surgery and the results look to be very good. The tumor was contained to the prostate and the surgical margins (edges of the tissue that they take out) were negative for cancer. My doc said this is as good as it gets.

But, let me explain my thought process on treatment.

First, this is cancer. Recurrence is a very real possibility. I choose the option that gives me the most options for recurrence treatment. I chose surgery because it leaves open more options for follow-up treatment if you need it down the road.

This is simplified:
• If you have surgery first, if there is recurrence you can get radiation/hormone therapy (plus more) later.
• If you have radiation first, surgical removal of the prostate is rarely possible because radiation causes the prostate to shrivel and bind to the rectum/bladder walls. If they try to surgically remove the prostate post radiation, it would likely cause major rectal/incontinence issues as they pry it away from those tissues.

Now, mind you, the doctors may tell you to base your the decision process on the side effects of each procedure based on which set of side effects are the least disagreeable to you. I get it. Both have lousy side effects. Both cause incontinence and ED problems.

Surgery side effects are immediate, but most likely wane over time. Radiation side effects are delayed, but are likely to get worse in time. Surgery incontinence tends to be stress (leakage). I'm told that radiation incontinence is more likely urge (sudden urge to go that is hard to control). Now, I did have some urge issues as well with surgery, and I'll tell you that for me, the urge incontinence was a big problem. The stress (leakage) incontinence is much more manageable. This is just me. Everyone is different.

In my case based on my testing, both the surgeon and radiation oncologist said that either treatment would have a similar positive 10-year outlook for my condition. I chose based on which treatment would best stop my cancer from progressing. I chose not based on side effects, but which treatment left me more options down the road if the cancer came back.

Caveats: Everyone's tumor location and aggressiveness of the cancer is different. Everyone's side effects profiles are very different. So, getting lots of testing done before decision making is key. And know, there isn't one right decision. Ultimately, the choice is yours and you just have to own it. You're doing all the right homework.

Lots of people on the forums are dealing really tough situations. I think they caught my early and my surgical outcome looks to be good. Four months post surgery, my incontinence is getting better every week. It was never dramatic, but is showing good improvement. I actually go less often than my buddies (who still have their prostates, but are likely enlarged). My ED is showing promising signs early (which is rare).

But even though I've got it better than some, it's still no cakewalk. Treatment takes a lot out of you and it takes time to recover.

If considering radiation, definitely get the Prostox test, which can predict how toxic a radiation protocol will be based on your biopsy sample. It might steer you to one type of radiation over another.

Keep asking questions here and make sure you go to a center of excellence!