Just diagnosed gobsmacked looking for advice

On the personal side, let yourself keep feeling gobsmacked for a while longer. It's perfectly normal.

Prostate-cancer treatments have advanced enormously over the past few years, but it's still a life-changing diagnosis, and you need months or years to get used to living with it and the side effects of whatever treatments you and your oncology team agree on.

Trust that you will end up in a good place, and your joy and zest for life will return (maybe even stronger than before), but there's no shortcut to getting from here to there — you'll have to ride an emotionally-bumpy road at first, exacerbated by any hormone treatment you might end up getting.

Most people here have been down the same road (or worse), and we're happy to listen and share our own experiences.

Your numbers and condition are almost identical to mine. The cribriform patter 4 is certainly scary but it doesn't change your treatment options. I will go into surgery at Mayo in Phoenix in 3 hours. A month ago I was fat, dumb, & happy. I'm kind of mind numb now. I know it will be ok, but non-nerve sparing prostatectomy will change my life but I'm trying to keep things optimistic. Hang in there and find the best care you can. As they keep telling me, great advancements have been made in treating prostate cancer!

Thanks you very much for the kind words of encouragement.

Steve, wow thanks for taking the time to reply when you are getting ready for surgery! Best of luck to you and hoping for a good outcome.

All I can offer are well wishes and positive thoughts your way. I have a good friend who was diagnosed with very advanced prostate cancer several months ago in his late 50s. He’s receiving treatments and doing quite well. I don’t believe surgery was an option for him. With the advancements in treatment options, he’s quite positive and an inspiration to me.

Gleason 9 stage 3 locally metastatic patient here. There are many factors for you to consider, and at the top of the list are your age and your current health prostate cancer not withstanding.

I opted for radiation on my first go round to save sexual function. If I had to do over, I would’ve lived with the side effects from surgery the first time around (ED and mild incontinence) in exchange for the disease not spreading as it has done. I finally did have salvage radical prostatectomy in January and I’m glad I did. I am also undergoing ADT and salvage radiation to the lymph node basin, but sleep well knowing that my highly diseased prostate is no longer within me and can’t hurt me anymore.

Good luck on your journey. We’re here for you.

Gobsmacked is the word for sure - we’ve all been there. My biopsy revealed Gleason 4+3 with perineural invasion. That phrase scared the piss out of me - but I’ve come to learn thru research and reading that it does NOT portend catastrophe.
My MRI showed no capsular extension yet the surgical pathology showed it was broken - so much for technology…Anyway, margins were clean and now almost 5 yrs post op the PSA is rising close to where salvage radiation will be necessary. Bummed out but I got FIVE years free and hopefully the radiation/hormone combo will give me 5 years more or better.
For myself, even though every instinct told me not to have surgery, logic finally won. The surgery got all the cancer out ( well, almost all of it) and the patho slides confirmed Gleason 4+3 and broken capsule and clean margins. Many times your patho slides reveal a higher Gleason, perhaps adding another modality to your treatment. Radiation cannot do that even though it has taken its place alongside surgery as an excellent first option.
So do your research and feel comfortable with your decision - very, very important!! For me, being a pessimist worked out well since I assumed from the get go that surgery would NOT be my last stop with this freakin thing!

Just as you’re doing, considering all options is certainly what to do for now. Be sure that you fully understand what Cribiform pattern, Extraprostatic extension, and Perineural Invasion mean as they relate to possible cancer aggressiveness. Also, be sure you (and your spouse, if married) are fully informed on the impact of taking both nerve bundles. Ask questions now; leave no stone unturned. I would wait for the results of the PSMA PET scan before making a treatment decision; if there’s already spread, that changes things. (I was initially diagnosed in 2012 at 56y, with localized, 6(3+3), PSA of 4.2. I was on active surveillance for about 9 years; that bought me time to thoroughly analyze all treatment options. Eventually, with a localized, 7(4+3), and PSA of 7.976, I chose 28 sessions of proton radiation (April-May 2021) + 6 months of Eligard + SpaceOAR Vue. So far at 3+ years since treatments ended, my PSA varies between 0.35-0.55. My expectation is that numbers will remain nominal. We’ll see……)

Your numbers all the same as my husband's. We had 3 consults and all recommended radiation over surgery. Their thought process....cancer already outside the prostate, so why risk side effects of surgery when radiation will be needed anyway. We went with radiation and ADT. Treated at Mayo, Rochester early 2023. All is good now. Still on ADT so PSA is nearly zero. Good luck!

Welcome to our club of warriors. Yes, "gobsmacked" is accurate. I was diagnosed in December 2023 at age 58 with a 3+4=7 Intermediate Unfavorable due to the number of cores involved 10/14. No spread outside the prostate according to a PMSA-PET Scan. Decipher showed a lower intermediate risk of aggressiveness. My urologist naturally suggest surgery, since that's what they do, with his "95% success rate", whatever that means. I had already been researching my options, and decided to go with radiation with ADT, as recommended by my RO.

In February, I had six month shot of Eligard to help weaken and starve the tumor cells ahead of radiation. In April, I had three fiducial markers and a SpaceOar gel barrier inserted to better focus the radiation beam and protect the bowel.

In May, I did a five fraction course of SBRT (TrueBeam STX). Each session was about 10 minutes or so. No real side effects so far, but I did have the occasional hot flash from the Eligard, and experienced some fatigue after radiation. However, I also worked out a lot, ate a better, cleaner diet and generally maintained an attitude that I was going to kill my cancer before it killed me.

In sum, don't rush into any course of treatment. Take your time and research your options. The Protstate Cancer Foundation and Prostate Cancer Research Institute both have a lot of resources online and on YouTube, and this forum is another great resource. Be ready to advocate for yourself and your own best interests with Drs, insurers, etc. Best of luck to you, and warrior on.