Decision time SBRT, IMRT or surgery

failed to mention that I have had a PET scan as well and everything shows it is contained within my prostate.

I was diagnosed similarly in Dec 2025 with Gleason 7 ( 4+3 ). In my case, I did not want to have ADT in conjunction with radiation. Side effects from ADT did not sound good “ to me”. Opted for nerve sparing surgery in consultation and encouragement from my wife. This was accomplished by a brilliant and kind surgeon in Jan 2026. My recovery has been superior. Thanks God🙏🏽! Almost 100 percent continent straight away. ED has been a challenge with penile rehab filling the gap. VED and tadalafil and kegels daily keeps it healthy. Recently Trimix use has been a complete game changer . Sex life is excellent and intimacy back on track. Natural return of erectile function also making huge progress. I am confident will get 100 percent return when nerves fully heal. Oh, and almost forgot, last PSA <.004. Praising God 🙏🏽🔥!!!!
It’s a challenging decision which is different for each individual. Communicate with loved ones providers and God! Hope your outcomes are as good as mine!

I'm not a medical professional and I certainly have no idea what's the best treatment for you. That said, here's my experience of the side effects after surgery. I was 70 yo when I had NS RARP at a center of excellence about 26 months ago. I was 5'11" 186 lbs at the time of surgery (ie. fit, but not excessively so). I also was fortunate to have a very experienced and sucessful surgeon at a CCOE. I was continent immediately after the catheter came out although I did have some minor urine releases as I figured out the new normal during the first 4 months or so. Without my old BPH prostate I pee like I'm 30 years younger. I did have significant ED right after surgery, with it slowly getting better until full recovery at 15 months. I should note that I followed a penile rehab program under the direction of my medical team at the CCOE. Also, the uncertainty and slow pace of the ED recovery did result in considerable anxiety during that time. As far as general physical activities, I wasn't allowed to lift more than 10 lbs for 6 weeks after the catheter came out, and no activies with small seats (like cycling) for 3 months. I actually had some perinium pain if I sat down too quickly on a small gym bench for at least 6 months, slowly fading over time. Generally speaking, I was fully back to normal by about 6 months with the exception that ED recovery took 15 (very stressful) months. Now at 2+ years, all that's been long gone for quite a while. I should also note I started Kegels about a month before surgery and continue them (although less frequently) to this day. I also note that during this entire time I've exercised and eaten a healthy diet. Best wishes.

You could Have SBRT, It works quite well. I know lots of people that have had it.

As mild as your case is you could also do focal therapy. Doing that would leave you open to doing radiation or surgery later if it comes back. The advantages, you usually don’t have incontinence or ED after focal therapy. You should at least look into it. Here is some real recent information about it.
https://howardwolinsky.substack.com/p/focal-therapy-in-the-spotlight-landmark
Here is the full UK article
https://www.sciencedirect.com/science/article/pii/S030228382602169X

I was diagnosed with Gleason 7(4+3). In my case, I was advised by my medical oncologist that robust resistance-training (any load-bearing) exercises offset the metabolic effects of ADT and greatly minimizes side-effects. (Already a gym rat, that was easy for me to incorporate.)

I chose 28 fractions of proton radiation + SpaceOAR Vue injection + 6 months (two 3-month injections) of Eligard. That was 5+ years ago. My wife later told me that if she hadn’t known I was undergoing radiation treatments, she wouldn’t have realized it from any change in me. (That’s how benign this process can be.)

Never had any GU, GI, ED, or bowel issues. Just another day…… I told my medical team that successful treatment and quality of life were equal priorities for me. (They aren’t mutually exclusive.) External radiation also leaves more salvage options should (heaven forbid!) I have a recurrence.

Last PSA was 0.366 ng/mL, which is great for still having a healthy prostate producing PSA at a new normal.

You get to define what “successful treatment and quality of life” means for you and then pick the appropriate treatment.

(What have you learned about SBRT, IMRT, and surgery that makes you lean towards one and away from others?)

@jeffmarc

That was not mentioned or said not an option for some reason, I will ask again. Thanks

@brianjarvis I have mainly been looking at side effects, and length of time for treatment due to I am still working full time right now and own the business. The surgery I didn't like due to the side effects and recovery time as well as both of my opinions the first was a practice that has almost NO communication avenue and the Dr was nice and seemingly knowledgable but the practice seems to care more about quantity of patients, the second opinion which was at Duke the surgeon was one of the most arrogant people that I have ever met and seemed as though meeting with me for the second opinion was a waste of his time. The IMRT was just too much time and the distance for me to Duke is about 1 1/2 hours. The SBRT I can handle going to Duke 2-3 days per week for a couple of weeks. I suppose process of elimination should not be the way to make such a decision but that is sort of where I am at.

@harvey33
Not everyone can qualify for focal therapy. It looked like your case was one that could qualify. It may be that The location you are getting treatment. Fromm doesn’t do focal therapy.. It’s always worth getting a second opinion for a place that can give you more options.

There is no "right" answer: either surgery or radiation therapy (with ADT followup) has a high probability of durable success for early-stage prostate cancer, but neither is 100%.

You can't know what long-term side-effects you'll get with either, or whether they'll be mild or more difficult. It's not even true anymore that you can't have your prostate removed surgically *after* radiation.

In the end, flipping a coin is as good an approach as any. Or consider secondary factors: who do you connect better with, the surgeon or the radiation oncologist? How far do you have to travel for each? Are 5–20 quick 30-minute radiation visits more or less disruptive to your life than surgery and recovery?

Best of luck!

@northoftheborder With the experience I have had with 2 surgeons not to good of a feeling but for different reasons. I really had no real problem with either oncologists I have met with. I am in a pretty rural area and do not feel real comfortable with the local hospitals for this so the second opinion was at Duke and that is 1 1/2 hours away. I am as I said leaning towards the SBRT with or without the ADT (whatever the Dr's final call is on that. I keep having second thoughts so just struggling with a decision.