63 yo, live in Europe, diagnosed w/ PCA in Aug 26 and hard to decide

Hi,
I would do the surgery 1st with some other form of external beam radiation as a backup if needed. Go with the one incision nerve sparing surgery. With either surgery or radiation you are likely to have side effects, surgery right away hopefully gets better with time or radiation with side effects several months to years out. If you go with radiation make sure they put the gel spacer between your Prostate and Colon to protect the Colon. Some doctors want to do some form of ADT with radiation, ADT depending which one can be very side effects heavy. Some of the newer ADT drugs like Orgovyx usually have less side effects vs Lupron. Remember the best doctors+ the best facilities= the best results. Good luck with your selection.
Dave 3+4

SBRT is becoming, or has become the gold standard. I was 4+3, Decipher .84, PSA 7.8 at age 68. Six months of Orgovyx, 5 sessions of SBRT with 36.25 Gy to the entire gland and a boost to 40Gy at the primary lesion. Very few and minor side effects. To date, 3 years later, my PSA stays around 0.55.

Stay Strong Brother, We Got This.

I'm not sure that you can make a blanket statement that the side effects of RALP are worse than for RT. My doc, who practices in both Europe (Sweden) and the US told me that the side effects of surgery come immediately after and tend to improve with time while those of radiation tend to come later. I thought the former sounded better than the latter for me.

Personally, I had almost no side effects from the surgery. When the catheter came out after 9 days, I really felt pretty much my old self. There are so many factors including your general health, the skill of the surgeon, the geometry of the tumor relative to any nerves (some things might be missed in the imaging). So it's really case by case.

As for AS, it's possible-your PSA is pretty low. The caveat is that the biopsy samples a tiny fraction of the prostate (0.1% or so) and things can be missed. I had a first biopsy that showed a single Gleason 6 core. Two years later, I had one 8 and a few 7s.

The question is, Do you need to do anything other than active surveillance?.

Unfortunately, you left out some really important information.

How many cores were 3+4? We’re all eight out of 12 3+4? In that case, you really need to do something, Doctors have said that somebody that has 3+3 in more than six cores should consider treatment instead of active surveillance. You do have a very low percentage of four, however, Which could allow you to do AS.

SBRT radiation would probably be my first choice with your situation. You could do focal therapy, At least that leaves you open to surgery or radiation in the future. The problem is focal therapy has not always proven to be very effective, A good percentage of the People need further treatment. In the case of UCSF 50% of people that had HiFu ended up having recurrence.

My father died of prostate cancer so when I was diagnosed with it At 62 I decided to have surgery because he had radiation and he died from PC. In my case, however I turned out to have BRCA2 a genetic problem, That I got from my mother, And it makes my cancer much more aggressive than the 4+3 they came up with after surgery. I’ve had four reoccurrences over the last 17 years. My brother, who doesn’t have BRCA2 had his prostate cancer diagnosed at 77 since he does not have BRCA2, But like me has a father that died from it.

You should make sure to have hereditary genetic test to find out if you have a genetic issue that can be treated.

Be aware of that prostate cancer is a chronic disease for almost all of us. A very few people die from it.

@jeffmarc yes, all 8 positive cores from the single lesion (size 12x6x7 mm) were 3+4 (each with 5% Gleason 4)

If you haven't already had a PSMA PET scan, I would recommend getting one. Easy test and it will help put your mind at ease confirming there is likely no metastasis.

Being frightened of both surgery and radiation I opted for IRE which was successful at eradicating the cancer in my prostate gland, however six months later it showed up in my pelvic lymph nodes. No real choices after that. Pelvic IMRT and 2 years of ADT and ARPI. In my opinion even if your doctors suggest ADT it's not that big of a deal to contend with for 6 months or even a year. Longer than that the side effects become more pronounced. It does offer higher effectiveness. I believe Orgovyx is the best choice over the injectables.

@toolbelt
Maybe SBRT is becoming considered Gold Standard, I don’t know, but if it is, that would be considered under Radiation Treatment .

I would definitely get a decipher test done, that could decide if you need adt with radiation or not and if the score comes in high its also beneficial to have a pet scan done also.

I'd particularly appreciate your thoughts on three questions:

Would you consider active surveillance a reasonable option in my situation, especially given my family history?

Is there a convincing reason to consider focal therapy rather than whole-gland SBRT, given the uncertainties about long-term cancer control?

For those who have undergone MR-guided SBRT, how has your experience been, particularly regarding urinary, bowel and sexual function?

@wheel1
If you choose RT, SBRT is the way to go. My RO was able to visualize my urethra on the CT, and MRI and the PSMA PET and used "urethral contouring" to ensure my urethra did not get any radiation "hot spots". I was also fortunate that my RO was in the control room for each of my treatments....not all RO's do that. The technology is unbelievable. Once you have your tracking fiduciaries placed the machine monitors their relative position and turns off the beam if you are out of parameters. The table can move you left-right, up-down, back-forth in 0.1mm increments and yaw, tilt and roll in 0.1 degree increments. The machine did stop during one of my treatments and they moved me 0.3 mm..........