My Gleason score now is 4+3 = 7 my PSA is 9.2

You are pretty young to have a lot of lymph nodes taken out. They won’t remove all of them. They will remove a few. The question is how many. I was reading an article a few months ago that said removing the lymph nodes was not really beneficial for people in the long run. At your age, there may be side effects due to it.

I have my prostate removed at 62 when I was a 4+3. 3 1/2 years later, I had to have salvage radiation when my PSA started rising again.

My brother at 77 had SBRT radiation. He doesn’t have his long to live as you do or I did when I had my surgery.

Getting prostate cancer at such a young age could be due to a genetic problem. You could get genetic testing to find out if it could be a factor. Does anybody else in your family have cancer? You can get it here for free, takes 2 to 3 weeks to get the results and a genetic counselor will call you. They will send you a kit that you return in the mail. You have to live in the USA to get this test for free.

Prostatecancerpromise.org

I think it is pretty standard to remove and analyze at least a few lymph nodes during RARP. I was Gleason 8 on biopsy and only two nodes were removed. I had expected more and asked about it. The assistant urologist told me that they remove a set amount of tissue and then analyze the lymph nodes found therein.

A urologist will usually recommend surgery. It’s always good to first get recommendations from various specialists - focal therapy, internal radiation, and external radiation. Then you can decide which one is best for you.

If there’s some concern that it’s already spread, then ask why surgery is needed if you may have to also get radiation anyway? Why not just get radiation initially?

With a Gleason 4+3=7 (Grade Group 3; intermediate unfavorable) NCCN guidelines make the following recommendations (see attached):

Six percent is very low, but surgery should involve removing a few of the nodes closest to the gland to check for spread.
However, you left out all the info that you need to make a sound decision: your PSA, Gleason score, Decipher results, biopsy findings in regards to volume of cancer, presence of IDC/cribriform cells, etc…
You CANNOT make any decision, regardless of your age, before you know the severity (or lack of it) of your situation.
You may be a candidate for active surveillance or focal therapy. You got some work to do, bud!!
Phil

For me, the major relevant "surgery vs. radiation" factor was the location of the PC within the prostate gland based on the findings of the MRI report.

If the PC is touching the edge of the prostate gland (which was the situation for me), then I'd be very worried of microscopic PC extension being outside the prostate. So...if there were microscopic PC extension outside of my prostate, then radiation would take care of that concern whereas surgery could not.

If I had no PC contact with the edge of my prostate, then I would have selected surgery.

@kenk1962
Add one of the PCRI conferences the doctor said this

Kwon and Moyad agree to this. Seeds for metastasis were already there when surgery was done, waiting to grow.

Makes one wonder what’s really going on.

Ask for a PET scan to determine if it has really spread, and if it has, to where has it spreqd?

@paddywagon, you got a lot of information and questions to ask your cancer team from fellow members here. What did you decide or are you seeking a second opinion? How are you doing?