New Oncologist recommendation vs. prostectomy

"Prostectomy or SBRT?"...

Seems to me you maybe left one out...Prostectomy or SBRT or Second Opinion.
I don't do well with disorganized doctors. New England is full of competent practices.

It is really important that you find out whether or not you have small or large cribriform. My brother had SBRT radiation A couple of years ago and his biopsy specifically says Small cribriform. Five sessions of SBRT and he is fine two years later.

PNI It is so common it almost ridiculous. Here I am 15 years after diagnosis, Had surgery than radiation then drugs for 9 years. Even though I have BRCA2 The PNI recognized in my biopsy, made absolutely no difference. Same is true for almost everyone else PNI is not considered a Recurrence problem.

Since you are young (I had surgery at 62) Radiation may be preferable. You should look into proton radiation, While the chance of having other cancers due to radiation has become much lower Because of the better techniques of radiation, Proton radiation causes the least amount of issues with other organs being radiated.

That decipher score does show there can be problems in the future.

Getting a second opinion may make sense for you. Going to a center of excellence can expose you to many more doctors, which will give you more options.

Thank you. Those questions will be on my list (proton radiation size of cribriform). I believe I am at a 'center of excellence' = Tallwood Men's Health - Hartford. Well regarded, but am close enough to many others for a second opinion and treatment. I really appreciate your help, Jeff. Thank you.

I believe this is large form from my biopsy report:
Architectural Patterns of Gleason Pattern 4: Cribriform Glands, Poorly Formed
Glands

Although it may be a well regarded institution I don't believe Tallwood is an NCI recognized CCOE. Here's a link to the list: https://www.cancer.gov/research/infrastructure/cancer-centers/find

Large cribriform can be resilient to radiation in some cases and they are very aggressive. Your Decipher is very high. My husband had similar case and we opted for prostatectomy after consultations with both the surgeon and radiation specialist. Since high decipher and cribriform point to high aggressiveness of the cancer there is a possibility of recurrence and you can irradiate particular region only once. We wanted to have that second option available if there is any BCR in the future.

Indeed - the decipher is high. How old is your husband when treated and how is he doing (exceptionally well I hope)? That element alone is what prompted the Urologist to lean in the surgery direction (he is a robotic surgeon with over 4k prostectomies). However, a number of gleason 8 and 9 people I know in my age range have opted for radiation in hopes that the treatment works, or works well enough for 10-12 years, to see improvements in RP salvage surgery. It is a dilemma.

My husband is recovering from surgery as we speak. He had procedure done 3 days ago. If you wish to see detailed information about post op recovery status feel free to look up "Surf Is Up" thread that I posted. He is 69 and otherwise in very good shape. He likes to ski, play tennis and windsurf and kite-surf. He is not retired nor he plans to retire - he really likes working ( he is in high tech). He preferred surgery among other things because it did not involve ADT that can cause tiredness and brain-fog. Since he had cribriform glands radiation without involvement of ADT was not an option. He has 2 stratups and ADT side effects just did not sit well with him. There are so many parameters that go into decision making and with lower aggressiveness one has many more options. Having gleason 9 does not necessarily mean that Dcipher score is high. It can actually be low ! So you have to ask your friends what was their Decipher score and if they had Cribriform or even IDC in pathology report.
Wishing you all the best and please feel free to ask anything.

Thank you. That is what I have been advised as well. A dilemma for anyone facing the decision. Best wishes for a complete recovery.

Agree with Surfer on all points. Age is a very important factor in prostate cancer treatment - probably the most important.
From my own experience and what I have learned from many on this forum, this disease is never really gone. It may be ‘cured’ for a time or go into remission for years but somehow it’s always there.
So because of this, you ALWAYS must have a Plan B, no matter what kind of reassurances you get from practitioners or what statistical tables you consult; there are always exceptions and outliers.
That said, you are young (good for you!) and your cancer has many years to recur (bad for you!). Your pathology indicates a form of PCa not always responsive to radiation (even brachytherapy plus ‘boost’ seeds) and your Decipher score emphasizes how aggressive your cancer truly is.
Surgery might offer you the best option for a ‘cure’ or long remission. You will be PSA tested probably every 3 months post-op to see if there is any continuous rise in your numbers, so you will be closely monitored, no worries. The hope is that your PSA will be undetectable for many years…
Surgery, unfortunately, produces the most profound side effects (short and long term) even in the hands of the most gifted, experienced surgeon - them’s the breaks, OK? But with a cancer that already has higher odds of returning you have to prioritize saving your life over fears of ED and adult diapers.
I had surgery by one of the best surgeons in the world and my cancer returned 5 yrs later. My pathology was Gleason 4+3 unfavorable but Decipher score hadn’t been invented yet.
Even though the surgery profoundly affected my life at age 64, I have absolutely ZERO regrets that it was my first choice of treatment; I knew the chance of recurrence was real so I planned accordingly. If it comes back a third time I’ll take the next steps, whatever they may be. Best of luck to you in the days to come!
Phil