Newly diagnosed and looking for treatment advice.

https://www.nytimes.com/2025/09/24/well/live/prostate-cancer-treatment-explainer.html?smid=url-share

At 65y, I had localized prostate cancer, PSA of 7.976, PIRADS 5, and Gleason 7(4+3).

After spending much time analyzing all treatment options and interviewing specialists, my choices came down to (1) proton, (2) IMRT, (3) SBRT, & a distant (4) surgery.

I chose 28 sessions of proton beam radiation + 6 months of Eligard.

We discussed what we would do if I had a localized recurrence, and depending on the nature of the recurrence, there would be choices of: focal therapy (e.g., cryo), brachytherapy, SBRT, and yes even re-radiation (since we were using SpaceOAR). Surgery would be a last (nuclear) option for salvage treatment just as it was for initial treatment.

There is rarely a “one and done treatment” for prostate cancer so, I wouldn’t focus on that too much.

My 28 Proton radiation treatments + 6 months of hormone therapy had no impact on sexual activity, incontinence, or outdoor activities.

Good luck with your decision.

I am 62 years old healthy and very sexually actuve. PSA jumps between 4.5 and 3.2. MRI in April showed PIRAD 5 Lession approx 2.2 cm in the inner transitional zone. 13 core biopsy confirmed one core, 70% of core 3+4 with 10% being 4. One other core in different area showed 3+3 in only 10% of core. Had second opinion at Moffit in Tampa which matched exactly. Had CT and PSMA PET with both showing all confined to prostate only where identified. I did several AI tests that evaluated my biopsy. Decipher was not one. I Can’t remember some of the names but one was to determine if I was a good candidate for AS. That came back with a 42 and 49 and below says your ok for AS. AS doesn’t excite me though so I think I want treatment. One test described the chances of Metastification over a 10 year period and the need for ADT. This came back showing that I only had a 7% chance of Mets after one modal treatment and no need for ADT. Last test was Prostox which said I had a 95% chance of urinary toxicity (Grade 2) after SBRT and only a 5% chance after IMRT. This eliminated SBRT for me. I started out wanting a RAPP and it out of my body, but then got scared about ED and incontenece by reading blogs, so I started looking elsewhere. I had meetings with several different Drs and different facilities about focal theories and most said I was not a great candidate due to the size of my lession. Met with both Mayo and Sceonnti about TULSA Pro and was exited I found what I was looking for, but Mayo Dr said it would be his second option behind RAPP and chances were good if I did TULSA it would reoccur sometime later. Well after 7 mos of reading, visiting 3 different centers including Mayo and Moffit, and talking with 9 different Onocology / Drs, I think I’ve decided on removal, and I’m trying to schedule it with Dr Ram at Mayo for later this year. It does scare the crap out of me, but I think that would be the best to move forward. I guess I’ll pray for the best regarding ED and incontenence but will just live with it if it occurs. I chose RAPP due to salvage opportunities if/when it reoccurs and because success is easy to measure since PSA should be zero or close to it. I also feel I’m young and healthy now and can overcome surgery better today then I could 7-10 years from now. I really just want this shit out of my body and will face the other consequences that arise. It took me a long time to get to this point but I think I am ready to do it. I have a beautiful strong and loving wife to help me, and great family of support. Interested to hear everyone’s opinion if they were in my shoes.

@ucfron
Hello, My Husband 68 years had more or less the same biopsy results as yours and was also offered AS. We decided on Surgery immediately but being in Canada there was a long wait time. Waited 3 months then had ADT for 40 days. By God's Grace we were given a slot on 15 september (2 months earlier than our given date) and we grabbed it. Again by God's Grace everything went well and back home on 17th. We had to stay an extra day at the hospital because my husband had moderate bleeding from one of the incisions but that was stopped soon after they gave him some blood thickener. Clips and Catheters removed after 10 days and no pain or incontinence. A lot depends on the Surgeon's skills and I believe it is God who leads us to the safe place.

I am 62 years old healthy and very sexually actuve. PSA jumps between 4.5 and 3.2. MRI in April showed PIRAD 5 Lession approx 2.2 cm in the inner transitional zone. 13 core biopsy confirmed one core, 70% of core 3+4 with 10% being 4. One other core in different area showed 3+3 in only 10% of core. Had second opinion at Moffit in Tampa which matched exactly. Had CT and PSMA PET with both showing all confined to prostate only where identified. I did several AI tests that evaluated my biopsy. Decipher was not one. I Can’t remember some of the names but one was to determine if I was a good candidate for AS. That came back with a 42 and 49 and below says your ok for AS. AS doesn’t excite me though so I think I want treatment. One test described the chances of Metastification over a 10 year period and the need for ADT. This came back showing that I only had a 7% chance of Mets after one modal treatment and no need for ADT. Last test was Prostox which said I had a 95% chance of urinary toxicity (Grade 2) after SBRT and only a 5% chance after IMRT. This eliminated SBRT for me. I started out wanting a RAPP and it out of my body, but then got scared about ED and incontenece by reading blogs, so I started looking elsewhere. I had meetings with several different Drs and different facilities about focal theories and most said I was not a great candidate due to the size of my lession. Met with both Mayo and Sceonnti about TULSA Pro and was exited I found what I was looking for, but Mayo Dr said it would be his second option behind RAPP and chances were good if I did TULSA it would reoccur sometime later. Well after 7 mos of reading, visiting 3 different centers including Mayo and Moffit, and talking with 9 different Onocology / Drs, I think I’ve decided on removal, and I’m trying to schedule it with Dr Ram at Mayo for later this year. It does scare the crap out of me, but I think that would be the best to move forward. I guess I’ll pray for the best regarding ED and incontenence but will just live with it if it occurs. I chose RAPP due to salvage opportunities if/when it reoccurs and because success is easy to measure since PSA should be zero or close to it. I also feel I’m young and healthy now and can overcome surgery better today then I could 7-10 years from now. I really just want this shit out of my body and will face the other consequences that arise. It took me a long time to get to this point but I think I am ready to do it. I have a beautiful strong and loving wife to help me, and great family of support. Interested to hear everyone’s opinion if they were in my shoes.

I am 62 years old healthy and very sexually actuve. PSA jumps between 4.5 and 3.2. MRI in April showed PIRAD 5 Lession approx 2.2 cm in the inner transitional zone. 13 core biopsy confirmed one core, 70% of core 3+4 with 10% being 4. One other core in different area showed 3+3 in only 10% of core. Had second opinion at Moffit in Tampa which matched exactly. Had CT and PSMA PET with both showing all confined to prostate only where identified. I did several AI tests that evaluated my biopsy. Decipher was not one. I Can’t remember some of the names but one was to determine if I was a good candidate for AS. That came back with a 42 and 49 and below says your ok for AS. AS doesn’t excite me though so I think I want treatment. One test described the chances of Metastification over a 10 year period and the need for ADT. This came back showing that I only had a 7% chance of Mets after one modal treatment and no need for ADT. Last test was Prostox which said I had a 95% chance of urinary toxicity (Grade 2) after SBRT and only a 5% chance after IMRT. This eliminated SBRT for me. I started out wanting a RAPP and it out of my body, but then got scared about ED and incontenece by reading blogs, so I started looking elsewhere. I had meetings with several different Drs and different facilities about focal theories and most said I was not a great candidate due to the size of my lession. Met with both Mayo and Sceonnti about TULSA Pro and was exited I found what I was looking for, but Mayo Dr said it would be his second option behind RAPP and chances were good if I did TULSA it would reoccur sometime later. Well after 7 mos of reading, visiting 3 different centers including Mayo and Moffit, and talking with 9 different Onocology / Drs, I think I’ve decided on removal, and I’m trying to schedule it with Dr Ram at Mayo for later this year. It does scare the crap out of me, but I think that would be the best to move forward. I guess I’ll pray for the best regarding ED and incontenence but will just live with it if it occurs. I chose RAPP due to salvage opportunities if/when it reoccurs and because success is easy to measure since PSA should be zero or close to it. I also feel I’m young and healthy now and can overcome surgery better today then I could 7-10 years from now. I really just want this shit out of my body and will face the other consequences that arise. It took me a long time to get to this point but I think I am ready to do it. I have a beautiful strong and loving wife to help me, and great family of support. Interested to hear everyone’s opinion if they were in my shoes.

@ucfron
Hello, My Husband 68 years had more or less the same biopsy results as yours and was also offered AS. We decided on Surgery immediately but being in Canada there was a long wait time. Waited 3 months then had ADT for 40 days. By God's Grace we were given a slot on 15 september (2 months earlier than our given date) and we grabbed it. Again by God's Grace everything went well and back home on 17th. We had to stay an extra day at the hospital because my husband had moderate bleeding from one of the incisions but that was stopped soon after they gave him some blood thickener. Clips and Catheters removed after 10 days and no pain or incontinence. A lot depends on the Surgeon's skills and I believe it is God who leads us to the safe place.