Gleason 8 diagnosis at 51: Likely opting for surgery

You are a Gleason eight, The highest number is the only one that counts. Your cancer is aggressive so Doing something is very important.

There’s some things you don’t mention. Was anything else found in the biopsy? Did you have intraductal, cribriform, Perineural invasion or Seminal vesicle invasion (SVI).

If you have surgery, you want to make sure that they spare the nerves. That way, you can usually get an erection after surgery. It’s not always possible, but even saving half of them would be useful.

You should speak to a radiation oncologist. You may still decide to have surgery, but you should get another opinion. Maybe go to a center of excellence like Mayo for a second opinion.

It's interesting that none of the four doctors thus far have recommended a particular treatment. I talked to nine and they all recommended surgery for me at 54 with 3 + 4. Despite that my cancer was less severe and was in fewer samples of the biopsy (much larger after surgery according to pathology) and a Decipher of 0.68. I was told the same thing over and over: radiation at this age is not recommended until absolutely necessary because you may live long enough to be impacted by the negative side effects of radiation, where a man of 65+ is more likely to die of natural causes before that happens.

I'm troubled by how many younger men have joined recently. I know this is likely the result of earlier detection through better and more frequent testing, but the severity of the cases have been so high for guys 45-55 years old lately.

Both urologists and both ROs outlined the relative pros and cons of radiation vs. surgery and stopped short of outright recommending one or the other. The urologists did point out that surgery leaves more salvage options if the cancer comes back and the ROs tend to highlight fewer incontinence and erection issues for radiation (although they focus on the short-term). Better radiation and the use of spacers seem to have tamped down some of the undesirable effects of radiation, but you also still have to deal with hormone therapy. Strangely, both ROs I talked to were a bit dismissive of spacers, although both are willing to order them.

What did the urologists tell you? I assume surgery. I also talked to PCRI and they are generally very pro radiation. All three surgeons I talked to started their talk by telling me that I am only 51 and need to think in terms of 30+ years and that RT, even with Brachy boost, has too much of acrecurrencecrisk beyond 10-12?years. I believe that the concern is that it leaves viable tissue and possibly cancer behind.

Similar boat here. Age 51, 6/12 cores positive (two Gleason 6, four Gleason 7) per two opinions, Decipher 0.56, negative PSMA.

So far, I've seen two urologists and two radiation oncologists. They've all recommended treatment vs. active surveillance. Both ROs suggested SBRT is not appropriate given current urinary issues - one recommended 20 treatments and the other 45 treatments. Going to MD Anderson at the end of the month and will make a decision after that. Currently vacillating daily (hourly, minutely) between radiation and surgery. Lots of good info on this site and PCRI.