Doug, my PSA was 10.2 with a Gleason of 3+4. I looked at a number of choices including having my prostate removed. I chose the mridian linac machine by Viewray and had 5 treatments ending in February. There are only 47 or so of these combo machines in the world because it provides radiation while simultaneously, its built-in MRI allows real time view while being treated. It uses 2 mm margins versus the 4 or 6 mm margins that other radiation machines use so you’re healthy tissue is less exposed and therefore your side effects should be better. Viewray.com will give you more information including locations of machines. I would make the same decision again, and my brother, who has worse prostate cancer, also used the same machine, but he did it out of Cornell Weil in New York City, and I did it out of Florida at the Orlando Cancer Institute. I also had spaceoar gel inserted, to get some separation between my rectum and prostate. Good luck and take one step at a time and get back up opinions.

@Bens1thank you for the information and I will certainly look into it. I live in Mn. and 4 hours away from Mayo Rochester so I will talk to them and see if they offer that option.
I want to be informed about all the options available yet I feel like the more I learn the more I am confused as to what to do. I’m not excited to have the radical prostatectomy, yet I don’t want to choose another option and have the cancer come back.

Given the relatively low PSA I would first get a second opinion on the biopsies slides. Fours and threes are subjectively read. I found out that my 3+4 was 3+3 after John Hopkins studied them. My PSA is 5.49 and I am 70 1/2

Given the relatively low PSA I would first get a second opinion on the biopsies slides. Fours and threes are subjectively read. I found out that my 3+4 was 3+3 after John Hopkins studied them. My PSA is 5.49 and I am 70 1/2. But to answer your question my urologist has me under active surveillance and he suggested I first try the HIFU. It can be repeated and all other options remain on the table if it does not do its job. It probably depends upon how many lesions are found. Also I had a 3T multiparametric MRI where they located my two lesions (9mm and 4mm). I would get an MRI done and then discuss the ablation option with your urologist.

Doug, I have a similar situation as you, my biopsy was 3+4 in two of the core samples with the remaining samples being graded as a 6, PSA was 8.75. I am 65 and have talked with 3 urologists (one of which was in Mayo) and one radiation onocologist. From my understainding ablation or focal therapy still has questions regarding long term results. I was told that since I had 2 core samples at 3+4 and the remaining at 6 (which some consider a pre-cancerous state) that I need a therapy that treats the entire prostate. The long term studies show no significant difference for low and intermediate cases between surgery and radiation. The decision is up to you on what you are comfortable with and looking at the side affects and recovery. I chose radiation over surgery for the recovery time and less chance of incontinance. I was told that there was no rush in deciding on treatment and could put this off for several months. My preference is not to wait but get this over with as soon as possible, I have several trips planned over the next year that I do not want to cancel. I also have had experience with radiation 33 years ago treating for testicular cancer. I have discovered that with attempting to schedule the various procedures this is taking much longer than I care for. My latest road block is BCBS of Minnesota decided that since I am low risk and the radiation dose is lower the Space Oar hydrogel is not medically necessary. I do not understand why trying to protect damage to other organs and reducing side affects, and improving quailty of life is not medically necessary. Currently I am waiting for a response on our appeal. Good luck, it sounds like you have an early detection and should have good results what ever you choose.

Thanks so much for your lengthy and detailed response Mar1957! The only reason I had asked about the focal laser ablation was that an older sibling had sent me an article about it. From what I read that the success rate is good yet a large percentage of the test study participants had the cancer return. I don’t want this to be a lengthy and spread out process.
I wish you well and that BCBS would quit playing with peoples lives! I do plan on proceeding with the Radical prostatectomy surgery on Tuesday. My feelings are that if I decided to go with radiation or chemo and the cancer returns or they don’t get everything that it’s much more difficult to then have the radical prostatectomy. I’m not thrilled to have the threat of side affects or the long recovery period but I’d rather deal with this once and only once.
Thanks again for the insight and encouragement!

Here's some info from Mayo Clinic
- Mayo Clinic Q and A: Advances in ablation for prostate cancer https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-advances-in-ablation-for-prostate-cancer/

@dlkreps, how did the prostatectomy go and how is recovery going?

Thanks for the information Colleen! The surgery went well and I’m 5 days out. The CO2 was the worst aspect of the surgery but seems to be mostly gone. My digestive system has been very slow, not feeling like eating very much. I’ve been walking daily trying to get my lungs and muscles healthy. The cancer was completely contained to the prostate and I’m cancer free. I have a urology appt on Friday to get my catheter out and praying for full continence. Grateful for this community and the support and information that is available.

I found this statement on the internet recently "Laser Treatment: Men can also develop bladder trabeculation after having laser treatment for an enlarged prostate. This procedure can cause blood clots to form within the bladder."