Gleason7(3+4) - treatment options recommendation

@johnnyz
Perhaps it has something to do with previous law suits that have been resolved for years. Spacers were required with SBRT due to the high intensity radiation and optional for traditional multi-week radiation. It was also standard practice at the clinic for representatives from Boston Scientific Corp to monitor/supervise the procedure.

@manojsmishra
I had 30 rounds of radiation with very few side affects. Surgery will also have long term side affects as you have removed an organ from body. Ask your urologist about the long term side affects of surgery specifically for you not what another had or did not have because it is you and your body.

If you read the posts of those on MCC you will see just like radiation it is an individual thing not a norm. It depends on the individual, the type of surgery, and the expertise of your surgeon.

You are at Mayo. You can't get any better than that. I am also at Mayo and my treatment plan was radiation not high dose but low dose.

My Mayo R/Os ordered a Decipher test, bone scan, and Pet Scan. Have you had those tests? If not discuss them with your doctors to see if applicable to you.

Please understand this is your body, your cancer, and what you do should be what is best for you both physically and mentally. Only you and your doctors can do that as no one on MCC has your full medical and mental health history.

Good luck. You are a young man and the statistics on survival rates are very high when cancer is within the prostate.

@jeffmarc Hi Jeff, for me, the cribriform was stated as low amounts and all is contained in the prostate. No IDC, ECE. The recommended treatment from RO was SBRT, no ADT, and future recurrence would be addressed with Brachytherapy and ADT at that time. As I am 68, my parents died at 60 and 74 years old, I am not sure that I have a long life span other than I keep healthy and exercise. This is why I still struggle between radiation or Robotics RP

I am not at MCC, I live in Canada and would do treatment at St. Joe’s Hamilton which is well respected for robotics RP

@johnnyz
Whether your cribriform Is large or small is not dependent on how much there is or whether it’s outside the prostate. You can have it in just one spot and if it’s large, it’s much more aggressive.

Sounds like SBRT radiation would work well for you. You could get a spacer to prevent damage to your rectum.

@jeffmarc Hi Jeff, sorry for the late reply. No to IDC or EPE or ECE and yes to low cribriform. No seminal or lymphnode invasion. I do have a consult with the robotics surgeon next week. I did consult with the RO a few weeks ago who offered 5 sessions over 2 weeks of SBRT and no ADT. If future recurrence, then he said Brachytherapy and maybe ADT then. I am still not sure which treatment I will choose, but decision day is fast approaching. At 68, they say I am young and surgery is a good thing, but that radiation treatment as mentioned above is just as successful over 10+ years. I wonder the difference b/w SBRT/Brachy compared to robotics surgery for life long impacts or QOL, specifically in continence and the ability to have sex/erections in future

@johnnyz
If you have radiation, you can usually get an erection for a while, But they have radiated the nerves that can be spared if you have surgery. Many people have ED A few years after having radiation.

That’s not the end of Erection, however, You can always use a pump to keep the length, Use injections of bimix or Trimix To get a solid erection. You can always have an implant, which is very highly liked, 90% approval.

This also works.with surgery if there is an ED problem.

There are also multiple solutions to incontinence issues. If you pick surgery using Retzius sparing Surgery Will almost always resolved the continent problem.

SBRT is very effective, Rick, who started ancan.org had SBRT about 15 years ago and has never had an issue since. It was a Gleason eight and did go on ADT for a while.

@jeffmarc That all makes sense. I do look to see what the robotics surgeon says as far as how accurate he thinks he can be in sparing the nerves since everything seems to be localized inside the prostate. But, too many positive cores (7/15) to use focal therapy…and I am worried that our RO does not employ the use of a rectal spacer…

@johnnyz
I had 5 sessions of sbrt in Dec. '25 over 2 weeks) and 120 days of orgovyx (ending in March '26). The fiducial markers are, I am advised, very accurate in preventing urethral damage and nerve damage. The barigel spacer (rectal spacer) is, again, as I am advised, very accurate. 6 months post treatment zero side effects at this point. Intimacy is not a struggle, some mild urgency to pee, no bowel issues - to date. My diagnosis: 2 tumors gleason 7 (3+4) with cribriform and 4 tumors gleason 6. I am 64 - retired, very active, no other health concerns.
I was advised by Dr. Joseph Wagner (Hartford Tallwood Mens Health) that surgery vs. SBRT were equipoise - 3 second opinions (MSK, Smilo, Tufts) with surgeons and radiologists confirmed the same. Both treatments work and are curative in intent. Side effects included some discomfort near the end of radiation and some fatigue and hot flashes from orgovyx - all 100% manageable. This site has many helpful members that helped me a lot (Jeff Marci key among them and Heavy Phil etc) and their recommendations - exercise particularly - was very helpful- lots of good information across the site. Also, Mark Scholz (youtube) was very influential and I recommend watching his presentations. Exercise was Very Helpful for me. Good luck with your decision - there are no wrong decisions - only the one that works for you and that will be the right option.