Michael T, Strongly rec: 2nd opinion and evaluation radiation and surgery. Our med backgrounds very similar,except I am 77 and that may be tie-brkr. Mayo's radiation was 20 sessions + hormone for Gleason of 8/cancer all in prostate. Terrific program, manageable side effects; rad. 4/19; wonderful staff/support. Rec/Dr. Pisansky and staff!
All the best,
Mike C.

Here is the response I posted 3 months ago to another guy looking at the same decision: "I had similar numbers to yours in 2016 and after much study, I chose surgery to remove the prostate at Mayo Scottsdale with the daVinci. It went well and the surgeons are great!. There's still a little residual pain, a little leakage on sneezing and ED issues but my PSA remains at zero and my sense of relief is still intense. Anytime you can cure cancer with surgery, you should do so. The alternatives have too many side effects and doing nothing is a big risk that you will progress past the point where surgery can help. Surgery also eliminates the problems related to the prostate and you will have a strong stream In future. Good luck with your decision. Let me know if you have any more questions."
I was 74 when I had the surgery in 2016. You should get the genetic profile done, I think it is the Prolaris test. It assesses the aggressiveness of your cancer. I came out right in the middle, 5 out of 10. If you at 1 or 2, you could consider waiting but if you're 5 or over it is a no-brainer to have surgery. I have now had undetectable PSA for 4 years. Great peace of mind and acceptable side effects.

I was with you in heading toward proton therapy which seems just awesome. Unfortunately the extensive hormone therapy (18 months plus 18 more of testosterone recovery for me) is a sledgehammer to my libido for 3 years. You never know how many decent libido years you have left. Tough decision for sure. I haven’t committed yet. I’m 59 and super healthy except for the whole cancer thing.

Was in a similar situation age 65/66. Still considered "young" and strong. PSA varied over a year from 7.2 to 10.4. Gleason 7 (3+4) at the beginning biopsy. Also had the Genomic test and was on the advanced side of the curve. General info says surgery and radiation can deliver the same results, but that radiation can have consequences farther down the line . I opted for surgery for the same reasons, hopefully "1 and done" and they get to biopsy the whole prostate after and see what happened. Also a general theory put forth was that age can have a lot to do with choice, where 65 and healthy doing surgery is great, but 75 or 80 and not as strong can really tip the scale to radiation. ........I'm getting my post op PSA next week and will see what happened so far. I had a friend who had surgery and then was hafing issues again a few years later and he just had 3 month radiation/hormone therapy and said it went great. He wasn't getting the hot flashed and bad effects he was expecting.......PS The good thing about the after op biopsy by the pathologist is that they found that my Gleason 7 had turned from a 3+4 to a 4+3, so it was good it all came out.

Hi Michael T, I'm 20 months out from my diagnosis of cancer with a Gleason Score of 4+4. I was 73 and in good health at the time. My Urologist said it was an aggressive form, which put me in a little bit of a panic. I knew nothing about treatment options, except surgery that my brother had with poor results. My Urologist gave me a book by Dr Walsh from Johns Hopkins that had a long list of possible treatments. That made me more confused because the pressure was on to chose the right treatment. It was clear to me that I had to make the final choice. The main bit of information that I got from Dr Walsh was that to get the best result, I should go to a cancer center and if I was to have surgery, it should be from a well practiced surgeon. That left the local hospital out of the question.

I started to hit the internet, which helped but didn't get me to a final decision. The main takeaway was that if surgery was performed with the most recent robotic technology and with a competent surgeon the results could be better then my brother's. At the same time, a friend mentioned that he had a friend who had taken the Proton Beam Therapy 17 years earlier and had no recurring cancer. I talked to his friend, who was very positive about the outcome and sent me to a web-site called the Brotherhood of the Balloon that focused totally on cancer patients who had used Proton Beam Therapy. The creator of the web-site published a book about his experience with the decision to use PBT and what it was like during and after treatment. I read his book and with research that I found on the therapy compared to other forms of radiation indicated that the results were comparable but with fewer side-effects. That led me to choosing Proton Beam Therapy.
My next step was to find someplace to get the therapy. Since there are limited locations that provide the therapy, you can't go to your local hospital for treatment. We have a winter home in Sun City AZ so I applied to The Phoenix Mayo Clinic and was accepted in less than a week. After my first consultation with Dr. Vargas, it became clear that I still had a lot to learn about prostrate cancer and it's treatment. The first issue was had my cancer metastasized. The issue had not even been addressed by my urologist. The scans that Mayo put me through indicated that it was still in my prostrate. I was to learn that if it had traveled, my treatment would have been a lot more complicated. I met some others who were dealing with the metastasized cancer and it is not something to mess around with.

The second issue was the use of Antigen Deprivation Therapy with the radiation. My urologist also hadn't said anything about ADT. I was a little reluctant to use it until Dr. Vargas said that it would increase my chances of surviving the cancer by 20%. I checked out what he said and of course he new best. Here is an article that summarizes some research on the use of ADT with radiation therapy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985515/. My treatment consisted of 3 shots of Lupron that covered 18 months. I've just now completed the sequence. I can tell you that it changes your life, but cancer can do that. The report that I referenced above indicates that not every person with prostrate cancer needs to have ADT and I met a number of guys who didn't. With you Gleason score of 7, you may not need it with a higher dose of radiation. In my situation I felt like I didn't have much choice, if I wanted the best chance of watching my grandkids grow up. I won't go through what my side effects were from the ADT, but there was one area that I don't normally see mentioned. After my second treatment of ADT, Mayo gave me a bone density test. It showed that my chances of a broken bone was about 3 times higher then the normal person. They gave me an infusion of Reclast. The side effects from it were much worse than anything I had from the ADT. Now I feel pretty normal, except for the low libido.

In retrospect I think I made the right decision for what I knew at the time. Since then I've learned a lot more about the treatment of prostrate cancer. Today, I would look into the gene repair therapies as another option. I think in the next few years we will see some other options with fewer side effects.

Best of luck to you Michael T. This is a club you don't really want membership in.

Sorry about the long response, but your question brought back a lot of memories.