Radical prostatectomy vs external Beam and Seeds for Inter. risk PC

You are 62 and you may have 30 years ahead of you. If I were you I would choose RP as that preserves the most treatment options for the years ahead. If you have radiation you practically eliminate the RP surgery in the future. The surgery is painless and the recovery is fast. Also, when they remove the prostrate they can better evaluate the type and extent of your cancer and that helps with designing your future treatment. Good Luck and best wishes, young man!

Thank you, what is your thought on a pet scan before surgery?

The average life expectancy for USA males is 77.27 for men so you probably do not have 30 years ahead of you.
https://www.worldometers.info/demographics/life-expectancy/
If you insist on doing treatment, I would be doing the one with the least side effects. They all have similar prostate cancer specific mortality rates.

The quote that "surgery is painless and the recovery is fast" is probably not the general consensus.

What % of Gleason 4 are we talking about? Did you have an MRI? Visible lesions?

Mathew61. The life expectancy of a 62 year old male is 20.11 years and we all wish to achieve and indeed exceed that. If you are otherwise in good health, and you have good luck, you have a shot at exceeding this life expectancy. I hope that you do.
A pet scan can do no harm and it may do some good. This cancer business is serious stuff and you need to take all reasonable steps to prolong you life and increase your chances.
There are cases that the doctors have reevaluated the Gleason score after removing and examining the prostrate and that can effect their post surgery treatment plan. I had a RP at UCLA and after surgery my team of doctors increased my Gleason score to 9 and advised me that it was locally advanced, castration resistant. I had 13 months of ADT and Erleada, managed all of it well, but less than great, and hoping for the best. I do have ED and I have not decided what, if anything, I will do about that.

Take your time and ask alot of questions before you decide on the best treatment for you. Getting 2 or 3 opinions is not a bad idea as well. You may find a variety of recomended treatment plans. Studies show that all of the various treatment options are similar when looking at 15 year survival rates. What these studies do not provide is how the various treatments affect your lifestyle. I would ask your urologist and radiation oncologist what are the chances of recurrence. From the studies that I reviewed the various forms of radiation have a 5-10% chance of recurrence for low or intermediate risk patients. I have not found a recent study on recurrence rate for surgery, but if you google recurrence following prosectomy it can range from 20-40%. These numbers may not apply to you because I could not determine what risk category made up these numbers or if they were prior to robotic surgery. So it is good to ask this question. Also consider what side affects you are willing deal with and possibly live with. Surgery frequently is followed by some incontinece that may or maynot resolve, looking through the comments you will find many questions on this. Radiation may require you to take Flomax for a few weeks but no incontinece. Radiation and surgery can result in erectil dysfunction, generally this occurs following surgery and with radiation it can develop over 3-5 years. Consider the recovery rate and how this may affect you. Most men that have radiation can continue to work while they are being treated and maintain an active lifestyle, surgery requires a longer recovery. It was mentioned that with surgery the pathologist can determine your risk of recurrence or spread, this can also be done with genomic testing the biopsy samples. Ask your doctors thier opinion on this, you may find a range of opinons.

4+3 10%, 3+4 30% and 3+4 75%
Yes MRI and yes some visible lesions.
Thanks, Matt

A lot to consider, thank you and best to you as well.
ME

My father had radiation treatment in the mid 90's and should message boards like this one been around at that time you would have heard from a lot of disgruntled end users.

Different story today.

The surgery route is still being chosen by a lot of people however, with the primary reason for selection being that you can radiate after surgery but not do surgery after radiation. I kind of get it but...

I chose radiation and would not do surgery for any reason. Would much rather spot radiate any areas that lit up on a PET PSMA scan and/or do some kind of hormone therapy at a later date. Hopefully that is 10 to 15 years out at a minimum.

The AI revolution is real and hopefully that will lead to a cure for cancer or some treatment that drastically impedes the growth of it. We shall see, An interesting next 10 years awaits us.

A PSMA PET scan would verify that cancer is contained to the prostate and try to rule out distant metastases.
Your Drs would advise on that.
Note on ED: age, physical health and sexual function prior to prostatectomy are factors in predicting side effects.
HBP has posted salient information.
Best wishes.

I just had my prostate removed full of cancer, Gleason 8, PSA 6.9, both cores and On the Margin.
CT and Bone said no spread, Surgeon post surgery review before Lab said no spread, I am on Lupron and will be for 12=18 months, will have a PET Scan done soon and if any cancer detected, maybe seed implants and some targeted radiation at what the PET S found. Cancer kills, is nasty and very hard to kill so you must be very proactive and look at all the options.