They can also do Tulsa Pro, as long as no spread. But Tulsa Pro is still cash pay, roughly $30K. Otherwise Proton seems good if your insurance covers it over other options, one can also decline ADT.

We met with a Tulsa Pro doc - it would be $45k and there is no data about success with Gleason 8. But it sounds miraculous - could be the future. For those of you on the east coast, we know someone w/ Gleason 7 who had it at Yale in 2021 with great success (and I think insurance might have covered there).

Very helpful, thanks. Tulsa for my husband would involve the entire gland (maybe that's why it's more pricy:). Doc wasn't sure about exact cost so $45k could have been a high guesstimate. The procedure is new here, so he would probably travel to a center with more experience, but it's probably too risky. We're waiting for Decipher and second biopsy opinion from Hopkins, so maybe that will change things.

I’m 74 with two 8 cores and two 9. No spread as per nuclear bone scan, PET, and MRI. I had robotic surgery at Mayo on 7/10. Also removed lymph nodes, sems, and vans. All were clear as were bladder margins. I feel good about my decision and am recovering nicely and improving continence daily. If I have problems down the road, all radiation options are open. Radiating first basically eliminates future surgery, as I understand it. I can live without a prostate as long as I’m also living without cancer but I realize everyone and every case is different. Praying for you as you work through this decision.

Your husband, 71, G8, PSA 8, PSMA PET no spread looks a good candidate for proton therapy. You know I am not a doc, right?

Hormone therapy should always be an option, not a given! You know I am not a doc, right?

I had. PSA of 18 and my doc said the data didn’t really support the use of hormone therapy.

7 but the number has no teeth without a “number of cores positive” reading.

A high 7 and a low 8 may not be that different.

If it were me I would like to see the studies that support the use of adt with those numbers.

I suggest to you that those studies are very hard to find.

Yep, that is a solid 8….

My advice would be not to rush but ultimately it is your decision. The doc at any proton center should be able to assist your decision making.

Best of luck to you whichever path you choose.

Ozelli is giving great advice here seems like to me. Call Mayo radiation Onc for appt about proton or other proton center. Don't rush to surgery. I have had to learn to slow down myself, my first urologist I went to just for BPH was ready to do surgery on me after he did a biopsy, and was really rushing me I felt like. It is why I switched to Mayo.

Deleting - duplicate reply