56 YO torn between surgery and radiation: Any thoughts?

I had such wide sings in pathology between places, one thing to do is get the only place I trusted which is dr Epstein do a re-graded to be sure it is correct:
https://advanceduropathology.com/about-dr-epstein/
I don't trust most regrading out there, including Hopkins and others, many places turn it into a money operation, you want the best.

Next start calling places that do Tulsa Pro, some might accept you, others might not due to grading so go with places that will accept you. If not Tulsa Pro, cryo-ablation is what I had after Tulsa and a recurrence.

59 years old when diagnosed in Dec 2025 with Gleason 4+3 localized. Prostatectomy in January 2026. Second PSA post surgery <.004. Grateful to God and a good surgeon!
I was presented with surgery or radiation +ADT. If I could have just had radiation I might have gone with this treatment. But length of treatment and logistics difficult as I work full time. ADT was concerning especially since I had some cognitive difficulties when I had a natural drop in testosterone a couple years back. Chose surgery and rarely look back on this decision.
I had very little incontinence. Some minor urge incontinence which Kegels halted. 100 percent continent as normal couple weeks post surgery and only used one/two Depends when catheter removed in office.
Still dealing with ED. Penile rehab ( Kegels, 2.5 mg Cialis daily, consistent daily VED use) maintaining penile health. Had intercourse once with wife without any meds a couple weeks ago. At about three months post surgery started using Trimix. What a God send and game changer. Sex is wonderful but intimacy is certainly beyond intercourse, of course. My wife and i communicate openly and lovingly. Morning erections returning. I see full return to natural function in time.
My choice is NOT the right choice! It was the right choice for me, Only hope my experience helps you! 🙏🏽

I was 62 when I was diagnosed with prostate cancer. I decided to have surgery because my father had radiation and later died of prostate cancer. 3 1/2 years after surgery, mine came back and I had radiation. Three more reoccurrences later I had an Hereditary, genetic test and found out I have BRCA2, which is why it keeps coming back.

I got prostate cancer a lot younger than my brother who got it at 77 but does not have BRCA2. Genetics can be a factor and you’re getting prostate cancer young. Get a genetic test now, It may change how they treat you since there are treatments for certain genetic issues.

Radiation works really well these days. Five sessions of SBRT radiation can work for you since your case is relatively mild. The thing is when they do a biopsy they only biopsy one percent of the prostate. I was a 3+4 before surgery after I was a 4+3 when they found more cancer. This is not uncommon, some people with 4+3 who’ve had a prostatectomy found out they were 4+5.. If you have radiation, you never know.

How many 4+3 cores were found. What percentage of four were they? That is a factor and how aggressive your case is. How high was your PSA? If it’s very high, that is another factor that has to be considered.

When I had salvage radiation, they gave me a six month Lupron shot. I didn’t even notice the side effects. When I went on Lupron full-time three years later, I definitely noticed the hot flashes right away. The thing is if you’re 4+3 was a lot of cores with it then you probably want to do ADT. If it was very mild, you may be able to avoid it.

Were any of these things found in the biopsy intraductal, ductal, large cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

If you do decide to have surgery, you should make sure you have a surgeon who’s capable of preserving your nerves and urinary function. If you have radiation, you have to realize that they burn the nerves as well as the prostate so eventually most people lose the ability to get an erection.

Check out this discussion about how to have surgery that preserves your erection and urinary issues.
https://connect.mayoclinic.org/comment/1548188/

Not a choice for me because my cancer had already metastasised to my spine when we discovered it at age 56.

1. Radiation treatment itself is no big deal — a session is, maybe, 10% as uncomfortable as getting your teeth cleaned at the dentist.

2. Side-effects are usually mild and fade in a few months, but they can pop up a year or more later and linger, as they did with me. Still, no regrets — RT was far, far from my most difficult medical treatment since we found the cancer.

I was diagnosed with 4+4 at Biopsy at age 51. later downgraded to 3+4 at pathology. I was torn between surgery and radiation, In the end opted for surgery because the cancer was still very likely organ confined.

You should get second opinions from at least another surgeon and two radiologist, preferably at a center of excellence.

If you were to get RT, the likely course of action would be Brachytherapy to the organ, IBRT/SBRT to the prostate bed plus ADT. This may have worse side effects than nerve-sparing surgery. However, if you need salvage RT after surgery, side effects can be worse. Hence, the importance of having a good idea if EPE is present. Also get a Decipher and Artera AI test if you haven’t done so yet.

Keep in mind 30-40% of men who have the prostate removed end up needing radiation at some point anyway. But recovery is much more successful when younger like you are.

Agree with last poster about radiation treatment. HDR Brachytherapy, 5 sessions of SBRT or 23 sessions of IMRT, and short course of ADT (4-6 months) will put you in the 90%+ cure rate. This is the cutting edge treatment being done by the top cancer centers.

Like others here, I was diagnosed at 54. 4+4, downgraded to 3+4. Had RALP in April. Continence about 90% back. ED is still fully present, though I was able to have an orgasm recently without an erection. Very hopeful that will come back in time.

Do your research. Read this board. If the experience of surgery itself is of interest, I posted a detailed post of my experience on a prior thread. You have good options and research will lead you to the right one for me. I chose surgery because I trusted my surgeon and was nervous about potential bowel incontinence with radiation. For me, it was the right choice. Surgery was very successful (clear margins, nerves spared, lymph nodes clear). My PSA tests are next but anything ahead is manageable.

@copyman This is why it is important to get as much information as possible about YOUR case: The 30-40% are a global average including many cases with adverse features. You can consult different nomograms (though the MSKCC one seems to be particularly gloomy) and get estimates for your recurrence risk fot different scenarios. In the end, you have to decide which trade-offs YOU feel modt comfortable with.

I had my surgery a little over one year ago. So my research us now about 18 months old. My conclusion was that surgery without the need for SRT is likely less toxic ling-term than the described RT option.

More important than the kind of trwstment tou get is where you get it. If RT or RARP, you will want to go to someone with a lot of experience and documented good outcomes. Ideally at a center of excellence.

A 53 year old friend had nerve-sparing surgery, the margins were clean, has recovered and needed no additional treatment. That's the perfect outcome, and I hope yours would be similar. Younger men recover better from surgery. Those of us post-70 don't. Good luck!

On the fear of sounding repetitive, you need more info in order to make an informed decision.
Did you have a Decipher test or any other genomic analysis? Not all 4+3’s are the same; Gleason score does not always indicate aggressiveness; it will indicate a ‘grade’ and some of the higher ones - 4+4 and up - are usually considered more aggressive.
Also, the volume of your cancer, number of tumors, percentage of cancer in the biopsy cores, etc. are all factors which could help in your decision.
Get as much info as you can and really get to ‘know’ your cancer before you begin to treat it. Best,
Phil