Is anyone going with hormone therapy alone?

Gleason nine is an aggressive cancer. While ADT may manage it for a while, it will not do it for long, The PSA will start to rise, even while on it.

Rather than just ADT, they will probably want to put you on ADT and an ARSI (Zytiga or a Lutamide like Enzalutamide etc.)

It is really essential to treat the prostate in order to stop the cancer from spreading again after treatment.

ADT does not kill the cancer in any way, it just stops it from growing and spreading for a while.

If you can’t do radiation then surgery works well. Your cancer will spread a lot if you don’t do something. If you want the best chance at a long life, you must do one or the other.

Surgery is complicated because of healing. The fibrosis from the radiation is a huge problem. That comes from the surgeon, and quality of life after. Thank you for replying

Hi Velise, I certainly appreciate your concerns regarding the difficulty of doing surgery in a previously radiated area; and the fact that your surgeon has expressed concern only adds more stress.
The only question I have is this: Is your surgeon the BEST POSSIBLE one to be doing this procedure, or is he simply a urologist who does prostatectomies and the occasional ‘salvage’ surgery?
This is a very difficult surgery and complications are both common and unforeseen.
It may take you a while, but you MUST find someone who does a LOT of these procedures. Travel if you must, but a Gleason 9 within a fibrotic surgical field is something only a urological surgeon experienced in salvage surgery should tackle.
Don’t get me wrong, your surgeon may be the most caring, compassionate and conscientious doctor you’ve ever met; but it does NOT mean he can do this unless he’s done it many times before. Best,
Phil

Thank you for this. You are so right. We don't know how many he has done. We will deep dive into this

We live in Canada. Any site suggestions to find those surgeons experienced in this?

Rather than having surgery following initial radiation, have you considered any of the preferable options that are more targetable?: focal therapy (like cryo), brachytherapy (like HDR), or SBRT? You might even consider re-radiation (if the rectum was protected from radiation the first time).

We are meeting with oncology next week. Up to now only urologist. It is our understanding that any and all radiation is not on the table bc of the amount of prior radiation. Will check out all of these. Thank you

Sorry, can’t help you there…perhaps some of our Canadian forum members can direct you.