Confusing Messaging about Prostate Cancer

Thanks for the advice. I guess I'll have to face my fears and get treatment. It is difficult because I've always been healthy and active and hate the sound of some of the side effects resulting from treatment.

Yes, the side-effects can be rough, but being in good shape going in makes a big difference. Maybe this is the challenge you've been training for all these years (even though you didn't choose it).

@stevemaggart
Cancer should never be ignored. There are prostrate cancer that are low risk and slow growing that can be at the montiored level based on Biopsies, Decipher test, PSMA, bone scans.

When prostrate cancer moves out of prostrate you are dealing with a whole different diagnosis than if inside prostrate. Please talk to your R/O and urologist about the type cancer you have the aggressiveness of it and the different options for treating.

Everyone's prostrate cancer is unique to them and what one person does for theirs may not be a good choice for you. Watchful waiting is routinely (what is told to me by urologists and R/Os) for low aggressive prostrate type cancers that the cancer is only located inside the prostrate.

I am 77. Treated when I was 76. I plan to live another 20 years but even if only 10 want to die of something else not prostrate cancer that I could have treated. Again very different outcomes and treatment options for low risk non aggressive prostrate cancer versus intermediate, aggressive and/or has spread outside the prostrate.

I would encourage you to continue to investigate Tulsa Pro. It is covered by Medicare if done at a hospital like Mayo. My bill for my July Procedure was $6 after Medicare and my supplement insurance. Zero side effects or pain. Full write up of my experience at:
Tulsa Pro Experience, Mayo Clinic MN – July 2024.

Good it is covered. I read a recent article about the $30,000 cost with their financing options to pay for it.

I basically agree however . There is a djffference between " Watchful Waiting " and " Active Surveillance " . The latter is a routine schedule of regular PSA tests ( Every 3 months initially , then 6 months ) , followed by an MRI at 12 to 18 months ( or less depending on your PSA results)
Then a followup Biopsy .

@clandeboye1
Agree.
I wish I heard those say "watchful waiting" were saying "active surveillance."

Check out UTube video "Prostate Cancer Diagnosis over 80 Years Old" with Dr. Mark Scholz. The best 13 minutes and 42 seconds you will ever spend.

My father-in -law, who was a physician always said, “you live until you die” and that it was adding unnecessary worry to tell a patient they have a specific time to live. So my advice is to do what you will with gratitude for all those who care about you.
“Tomorrow has worries of its own,”

Peace and all good,

Sicetnon3

Well, there's the clinical data...

What you provided indicates higher risk and your medical team may not be wrong about recurrence.

The questions:

Will it return?
When?
Where?

Those are unknown other than "likely."

Other questions, age, co-morbidities, your individual preferences when balancing quality versus quantity of life.

You could be proactive and treat now based on the clinical data you have. You would need to decide in conjunction with your medical team, ADT, ARI, Radiation...if so, how long, which ADT, which ARI, what type of radiation,, do you extend the treatment to the pelvic lymph nodes, how long would you be on the ADT...would you combine two, all three, just do the ARI...?

Radiation by itself to the prostate bed with your clinical data may be "useless" given the likelihood of systemic disease outside the prostate bed.

As to the side effects, yes, this forum has the entire gauntlet and the varying degrees men have endured. Think statistics and Bell Curve, standard deviations, mean, mode, median, average.

Throughout my time on treatment over the last 10+ years I have not had the side effects interfere with living with the exception radiation places on traveling.

Mitigating the side effects can in part be a function of:
Diet
Exercise
Managing stress.

I've peaked behind the door of death by, not with prostate cancer. It's a hard no for me and my medical team knows that and in part, it is a factor in our decisions.

So, talk with your medical team, discuss what criteria they and you think would necessitate a decision to treat, then, through labs, imaging and consults, actively monitor your PCa, treat when those criteria are met and inform the treatment decision.

Another thing to think about and discuss with your medical team is what is the risk of actively monitoring and not treating until that decision criteria is met?

You have choices, that's the good news. It's also the uncertainty since there is no definitive answer, it depends. Guidelines such as the NCCN and AUA are based on science but are population based and lag behind ongoing medical research.

Kevin