Help-what treatment plan has anyone selected for Perineural invasion?

Posted by thecure74 @thecure74, Mar 21 10:08pm

Age 74, diagnosed December 2024 with Gleason 4+4=8.
PSA 2.001 June 2024, PSA 2.28 4K Score September 2024.
October 2024, Prostate MRI PIRADS 4 High
December 2024, Biopsy 12 cores, two with Perineural invasion identified & a 3rd with high-grade prostatic intraepithelial neoplasia.
January 2025 PSMA Pet scan - Prostatomegaly with low-level relatively homogeneous tracer activity & PSA redraw 5.4.
February 2025 Decipher test indicates high risk

I am needing to decide on treatment:
Full prostatectomy including lymph nodes or Proton Beam radiation with 6 months hormone therapy.

Has anyone had this experience?

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heavyphil | @heavyphil | 5 days ago

In reply to @chippydoo "I have a buddy with G9 going with radiation. Will be interested how it works out." + (show)

Chip, I really feel that age and possibility of recurrence should also be factored in.
If your age is advanced - I would say 75 and above - I personally would opt for radiation because the possible recurrence might take place after something else has already killed me🫣.
But if you are younger and opt for radiation as initial treatment, your choices are limited if it does recur; a lifetime of ADT or playing whack a mole with SBRT. It’s really an odds game, and frankly, a well informed gamble.

chippydoo | @chippydoo | 5 days ago

In reply to @heavyphil "Chip, I really feel that age and possibility of recurrence should also be factored in. If..." + (show)

Interesting thoughts. I think he is early 70's and in good health. I had removal in my late 60's followed and finished Salvage 3 weeks ago with G9 and no known spread. Initially on 6 months of ADT but suspect Doc will spring at least another 6 months on me. I was initially resistant as it would change some major things in my life. Short sighted on my part and more accepting at this point. I have been looking into the NCCN protocols. Thank you for your most welcome insights.