47 years old with newly diagnosed Gleason 7 (4+3)

I was diagnosed with the exact same scores as you and I did exactly what Hammer described above so well. Unfortunately, my margins were not clean but lymph nodes and everything else was good. It’s 6 months later and I am lucky, I live a normal life like before except I have to use a shot right now to get an erection. I’m hoping that may change. If not, I’m fine because I’m back to normal, a new normal, but still way better than the alternative. Praying for you.

@covodoo
I am 45 and just got diagnosed in August. PSA 180 (!!!), Gleason 9 (4+5) in 9 of the 12 cores confirmed by Biopsy. So far it seems limited to the prostate with 2 nodes and the seminal vesicles slightls affected. I am doing ADT currently (Lupron 11.25mg 3 month depot) and if my PSA becomes undetectable (currently sitting at 4.14!) i will do RARP in January.
Given that we are of similar age I thought to share my story. I also did go on a very interesting diet shift.
The whole story of my adventure is on this other tread
https://connect.mayoclinic.org/discussion/44yr-psa180-gleason9-non-metastatic-surgery-or-treatment/
Good luck with your decision making and I will keep an eye on your story.

Stay strong and be positive.

Regards,
Dinu

I was 46 when I was diagnosed. Similar numbers to you. I had my prostate out. My doctor at the time (Mayo Rochester) told me that at my age removal was his recommendation as it was most likely to control the cancer.

I am now 65 and enjoyed 17 years of undetectable PSA ( < 0.1). Just in the last year I was measured at 0.1 and subsequently started getting more precise tests and have been bouncing around .09 to .1. My doctor now is not worried at this time as 0.2 seems to be the trigger for a "second treatment".

Bladder control was never a problem for me. I very quickly regained control and only if I have a VERY strenuous workout or game (old time hockey). I might get a little leakage.

Sexually, I lost a lot and it has been tough on my wife and our relationship. She was only 40 when I had my surgery and it took a lot out of our relationship, it's not just the sex, but the loss of connection that really hurt.

I know many others report much better sexual outcomes than I do. I had an "open" , not robotic surgery.

All the best to you. I know it's tough being that young (or any age of course) but being that young, your friends and peer group hardly know what you are talking about.

@bdouglas67
I am two years out from proton therapy treatment at the UFH Proton center in JAX, Fl.
I HIGHLY RECOMMEND proton therapy. I had Gleason 8 PC which had metastisized to 7 lymph nodes. Today I am cancer free and my PSA is 0.0.
No urinary problems and my sexual function has returned.
If you inquire at UfH proton, they will send you a complete packet, and you can visit them for a free assessment.
I am VERY happy with the choice I made.

@tjmayo thank you so much for the follow up response. The views and outcomes I have read make one’s head spin. I know each case is different but Proton doesn’t seem to be talked about as much as RP or Photon. I’m waiting for a couple of tests and would like a consult with the proton people. So thanks for the update and stay healthy!!!

I am 70 years old. My last PSA was 4.6. I had a prostate biopsy a month ago. 20 samples taken and 5 were cancerous. I am told that the cancer is not aggressive and rated at Gleason 4 + 3.
I met with my urologist and waiting to see an oncologist. The urologist mentioned four options which were:
1. Monitor
2. External radiation
3. Brachytherapy
4. Prostatectomy

At this point, I am leaning to the brachytherapy. The urologist supports the idea and I will see what the oncologist has to say.

I look forward to comments and experiences from all of you!

@edmond1971
Thanks for a very well informed orientation.

I was diagnosed with Gleason 7 (4+3), PSA 11.9, at 67 y/o and my urologist, a board certified surgeon, informed me I was a candidate for either RALP or EBRT with ADT. I chose the latter, and even after 18 months of ADT (which weren't easy) I feel I made the right decision, of course given my circumstances.

You expressed excellently when stating "When you start this journey, the doctors know more than you. The journey on this first path will come to a close when you know more than the doctors, from the point of view of your particular situation,"

@mikemp Twenty years ago, my father-in-law chose brachytherapy and it worked out great. He's still around at 92 y/o. Back in 2023 I was diagnosed with a Gleason 7 (4+3), PSA 11.9

My urologist suggested either RALP or EBRT with ADT. I chose the latter and, though dealing with the ADT side effects is a drag, I am pulling through and thankful everything worked out fine, so far.

By the way, the same radiation oncologist that administered the brachytherapy on my father-in-law, supervised my EBRT.

@juanmoczo did you consider brachytherapy?

@mikemp My radiation oncologist originally mentioned I could be a candidate, but after the EBRT sessions started, he never mentioned it again. I suspect my Medicare Advantage Plan does not pay the doctor at the same rate as the EBRT sessions, but that's just my opinion.