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

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@lojewski 1) Risk on AS usually related to how fast PSA increases. Was PSA over 3 for several years before it went over 4? If yes, then AS is reasonable. Primary benefit is no side effects. At your age and disease, it is almost certain to progress to the point that treatment is required. As mentioned in another post it is easy to miss the point where ADT is not required. Probably easier if RP was planned treatment since you would be okay as long as contained in the prostate. Almost all genes such as BRCA are not on Y so risk is 50% if your father's cancer was gene related and those genes double the risk from 1 in 8 to 1 in 4.
2) Focal therapy has the highest probability of leaving sexual function as is. RP eliminates ejaculation even with complete nerve sparing (90%+ of fluid is from prostate) and RT usually cooks the prostate enough to do the same (about 75% chance). If getting a focal therapy, make sure it is done by an expert. Did you get consult for both HIFU (anal) and Tulsa-Pro (urethra) delivery?
3) Radiation side effects have gone down with modern equipment with better aim. The MR Linac is the best such that quite a few centers in USA will not use it for prostate cancer (other cancers have more exacting requirements). It is the way to go if deciding on RT. Your RO can tell you how much radiation will hit rectum, bladder, etc. based on the plan. With that machine it will be very close to plan. I had no long term side effects from radiation (CT adjustments at beginning, but not active in treatment like MRI) except going dry. Had a little urgency right after treatment. No bowel symptoms. No ED but sex and orgasm different than before treatment not in a good way. A few have posted different & better; most different and worse. One reason AS and Focal are tried even with the risks they have.
4) As has been mentioned RALP-RS (posterior) and RALP-SP (anterior) do not cut the ligament and have much better continence results than the standard RALP procedures. However, you will need to find an expert surgeon in using the technique chosen to get excellent results. Wheel1 (posted response) had RALP-RS.

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Replies to "@lojewski 1) Risk on AS usually related to how fast PSA increases. Was PSA over 3..."

@jim18

1. PSA was over 3 since early 2024. Did not "trigger the alarm" at that time because it was still under 4. Yeah, I really want to avoid ADT as long as it is possible. Currently 2 different ROs and my urologist have stated that ADT is not required in conjunction with RT...

2. I only had consult for HIFU, but as mentioned, although possible it might damage the right nerve bundle due to the peripheral location of the tumour. They could not "guarantee" the outcome...TULSA is hardly available in my country and based on my research might not be suitable due to the peripheral/posterior location of the tumour. Will have IRE consult next week.

3. MR Linac i.e. MR guided SBRT is available (Cyberknife would also be available as a second option). Already had my MR Linac SBRT consultation and all I would have to do now is to make appointments for the treatment sessions..