44yr PSA180 Gleason9 non-metastatic. Surgery or Treatment?

thanks michael.

(I didn’t read through all the comments….). Have you had a PSMA PET scan yet?

You're young and have a long life ahead of you and don't want to risk this spreading. Suggest you treat it and cut it out now! You'll be able to deal with the side effects. Good luck and best to you.

Very good advice!

Your so young. I m not qualified to tell u what to do. My results were the same as yours from agent Orange. Gleason 9s. Metastices to pelvic lymph nodes. Get a BRSA2 check before having surgery. Radiation/ ADT shots/ pills worked for me. Over 30 months PSA < .01. No more shots no more ADT pills, I m negative BRSA2 via genetics test. No radiation side effects, just afternoon fatigue daily. Muscle atrophy too so workouts done daily. Take care. Bruce

That’s good. I hope your cancer is still organ confined. In that case, surgery is probably the best way forward. If it has breached the capsule, and in the abscence of cribriform, you should look also into a triplet radiation therapy (sbrt+brachytherapy boost+adt) if you want to avoid the double whammy of surgery followed by radiation shortly after.

Universitâtsklinikum Heidelberg (NCT) has PSMA PET Scan testing capability and I also recommend that you get this additional test to confirm no spread of cancer outside of the prostate, because it will be a key factor in your decision for the initial, and it is more precise than other types of scans.

When it comes to the initial treatment, whether you choose surgery or radiation, take the time to choose the best that your insurance will support and others have provided you with those clinics in Germany.

@jeffmarc and others have provided you with the diagnostics.

People in this forum will provide you with more details on what to look for in terms of treatment details (radiation equipment, hormone treatment medications).

In Germany, the “gold standard” for surgery is the Martini Klinik (Hamburg). If your insurance does not enable treatment there, you can find Martini Klinik trained surgeons at other Prostate Cancer center of excellence’s in Germany.

If you choose radiation, I recommend that you get detailed information from this forum on the type of equipment and radiation oncologists, that you can then use when searching for the best radiation treatment centers in Germany and discuss with NCT Heidelberg, as this treatment cycle will take more time than a surgery.

With Gleason 9, getting the best Prostate Cancer Oncology specialist is very important. Ideally that person can help guide you. NCT Heidelberg has at least one.

My opinion is that it is less common to have radiation as the initial treatment in Germany, but that does not mean it is the right decision for you. You can get in Germany the right combination of urologists (surgeon), radiation oncologists, and prostate cancer oncologist specialists. NCT, LMU and others in Germany can provide you with the multi-discipline information that you want for an initial treatment decision and the guidance on this journey.

If you served in OIF or OEF Prostate cancer is a presumptive condition for veterans exposed to toxic substances, including burn pits, making the connection between their service and diagnosis easier to establish without needing to prove a direct link. You need to file for disability they will rate you at 100%. Also agree request a PMSA PET scan to know for sure if it has spread.

It is my understanding that if the PSMA PET?CT scan results are available the guidance will be clear as to the path forward. It is my understanding that if surgery is that route then both a Ist generation medications (primary testosterone) androgen deprivation therapy [ADT] is now added by a 2nd generation (cancer cell testosterone
generation). This is in preparation to surgery. But first things first. Jeff please add a comment to mine too.

I’m also in my forties and was very unexpectedly diagnosed a couple months ago. PSA was 118 with Gleason 9. PSMA-PET scan showed uptake to the seminal lining and pelvic lymph nodes. No bone or distant sites seen on scan, but confirmed regional spread based on PSMA-PET and subsequent MRI. Germline genetic testing also negative for known cancer markers. Started on Bicalutamide and switched to Orgovyx. Trying now to decide on surgery vs radiation. Have gone to 3 “Centers of Excellence” seeking expert opinions on best course of action. One said surgery and two said radiation. However, even the surgeons agreed there would likely be microscopic spread that surgery won’t be able to address ultimately requiring radiation afterwards. I’m leaning strongly toward radiation in conjunction with a sensitizing hormone “cocktail” - likely abiraterone + prednisone along with the Orgovyx I’m currently taking. I’m hoping insurance will cover proton radiation vs photon radiation due to pelvic lymph node involvement. Make sure you consult with an ENTIRE team: urologist (i.e. surgeon); medical oncologist; and radiation oncologist. Surgeons tend to look through a surgery lens and radiation oncologists tend to look through a radiation lens while medical oncologists, in my limited experience, are a bit more in the middle. Meet with the entire team and make sure you go to a Center of Excellence where they are treating a high volume of patients with prostate cancer. I hope your appointment on Monday brings additional insight.