Where to draw the line between active surveillance, removal, radiation

Attn: @jc76 And @grandpun
Thank you both for your almost instant helpful replies. First in response to jc76. I did have the PSMA this past June and discovered that while the prostate was cancer free, the cancer has moved into two nearby lymph nodes. He quickly put me through 4 very high dose targeted radiation shots. The PSA was at 6.9 after 120+ days, thus his determination I needed to make a choice. You suggestion to combine chemo with radiation, makes sense but I may not have that option but will discuss.
Grandpun, not letting the PC treatment interfere with my job is primary, like you. I'm so sorry you lost your wife but you've got to know how much it was appreciated. We've been married for 60 years this past May and I'm not going any where. Your information about AA&A is greatly appreciated. Our Hospice people do offer good moral support and periodically time off support. Haven't use that yet but it may be some assistance. Will definitely check out the Agency too.
I really have been blessed since being diagnosed and any extra time is just icing on the cake.

Just layman's opinion of course but the radiation was zero intrusive and I has 23 daily shots, with weekend breaks. No side effects at all and no chance of infection.
Thank goodness it looks like they caught it early. I was checked yearly for several years but when they found mine may Gleason was higher than yours by quite a bit. If you have a good radiation oncologist, I would lean that way now and maybe discuss the radioactive seed inplants,Brachy Therapy. It's tough on your modesty but near painless. Good luck.

@grandpun ronc329403,
My heart goes out to both of you. I am no where close to what you are doing as a caregiver.

My wife was diagnosed with diabetes 1 three years ago after 3 surgeries on her stomach that damage he vagus nerve. We just can get it controlled. A good week for us is not bed ridden, a good month is not having to go to emergency room.

But I am no where with what you have done as care givers. I know it is hard as I had to but my fears and discomforts secondary to make sure my wife's life was not in danger if we did not address her extremes of high glucose and low glucose. I came close the first time she went into a coma as I did not know what it was or the cause. So I learned quickly what to do and not do.

I really feel for you both. I had a friend with similar diabetes and his life was like living on a razors edge, not knowing from minute to minute which side he was going to fall off on. I bet you have become an expert in reacting to the symptoms. Bless you and yours

Your numbers are close to the very lowest at which treatment should even be considered.

If I were you, I would not rush into anything. Should you be one of the unlucky ones, the after effects of treatment can be significant.

My perspective - Unless you are at/near end of life or have significant medical issues that will end life "soon", I would never let an incompetent doctor convince me to go with active surveillance. Sure, treatment option are not comfortable to go through, but a doctor shouldn't play on a patient's fear of treatment and convince a PC patient to wait. If PC is found, you need to address the cancer now, not watch it until it metastasizes. I always use the analogy of a train - If you are standing on a train track and hear/see a train coming toward you, do you wait until the last moment to jump off the tracks and hope you don't fall or wait too long? Obviously, no - You take immediate action, carefully assess the situation, and calmly walk off the train tracks to a safe location. You may go left (radiation) or you may go right (radical prostatectomy), with both options being significantly better than waiting for the train to run you over.

It is so sad to see men who wait on treatment, then have treatment years later, only to find the cancer has metastasized. For myself, I was praying my prostate cancer would come back Gleason 3/3. In the end, I had a GS of 4/3 - Treated immediately with a radical prostatectomy and all going good one year out (reason - center of excellence, great doctor/team, grace of God). As all of us know, there is no promise of the PC being gone forever, but immediately treating the cancer gives you the best possible chance of LT survival.

Hope everyone has a Merry Christmas and happy/healthy new year!

Welcome to the group, @jsteve. Are you on any maintenance treatment for stage 4 prostate cancer now? How are you doing?

I agree. No guarantees that it will not spread. Better to treat than come back later and say “ I wish I had…”

The big benefit of proton-beam therapy is in fewer side-effects (e.g. risk of bladder irritation); there is no observed advantage over SBRT in overall survival.

Source: https://www.nature.com/articles/s41391-019-0140-7 (abstract only; rest is behind a paywall)

So don't feel that your life is at higher risk if you don't want to travel halfway across the country and stay in a remote city for weeks. Talk with your oncology team.

Proton beam radiation is especially beneficial around the brain and other vital organs, and for pediatric patients. Side-effects from regular SBRT on the prostate usually range from mild to none — I was unlucky in that regard, and did take some (benign but annoying) damage to the bottom of my bladder where it touches the prostate, but even if I'd known that in advance I wouldn't have travelled away from home for proton-beam therapy (I was still in a wheelchair at the time, and only recently home from a long hospital stay).

Totally agree, you only get one chance - When the cancer metastasizes, you can't go back and wish you had done more to give you better odds of a cancer free life.