Prostate cancer: Anyone had surgery at 3+3?

I had removal at 3+3 but I was 41 and now 52. My post operation pathology was 3+4.

If you choose active surveillance, figure out a frequency of testing that brings comfort and confidence.

I also had removal at 3+3 with a post-op of 3+4. My decision in part was based on a high Decipher score.

Thanks

My brother had 3+3. Did low dose brachytherapy and a short stint of radiation. What I read is that most 3+3s go into Active Surveillance.

Given you are in Vermont, consider a drive down to Dana Farber for a 2nd opinion.

What has been your history of PSA results over time?
Agree w/ 2d opinion suggestion.
Personally, I am in the "aggressive treatment " camp and would be considering removal (my choice at 72) or radiation of prostate fully.
Best wishes.

Here are some thoughts to consider. My own history was Gleason 4+3, CT and Bone scans negative, PSA 6>>8 in six months. I had nerve-sparing surgery.

Last year, the New England Journal published a 15 year follow up of a randomized trial of active surveillance (AS) vs surgery (RP) vs radiation, with over 500 men in each grouping (notably, very few Black men). https://www.nejm.org/doi/full/10.1056/NEJMoa2214122 While there was no statistical difference in death from prostate cancer among the groups after 15 years, the AS group had twice as many cases of metastatic cancer. And 50% of them went on to have treatment within 8 years, rising to 67% after 15.

The two key considerations to me would be complications and erectile dysfunction (ED) after surgery. Personally, I did not want to have radiation and (a) worry if all the cancer had been dealt with and (b) face the prospect of difficult surgery if the cancer "came back".

Complications: Teachable moment - Defense Sect'y Lloyd Austin had an RP end of last year, then went back in with an unknown complication (rumour says it was a bowel obstruction) which put him in the ICU for a week or two. Also, people do die after surgery, probably less than 1/1000.

ED - 95+ % of us will get ED after RP for a minimum of 9-12 months, some never see spontaneous erections return. If spontaneous, penetrative sex with a partner is part of your life (average for those age 65 is 2 x per month), consider the loss of that for a significant period of time or forever. Note that orgasmic ability is not lost.

Those are the main reasons doctors will caution against jumping into treatment right away in a situation like yours - "First do no harm" is part of the Hippocratic oath. Don't let the cure be worse than the disease.

On the other hand, I watched my father die from bone metastases from prostate cancer. That was very painful and difficult for him, and I want to avoid that at almost all costs. AS has a 50% higher rate of that over one's lifetime (10% of the men in the study vs 5% for RP or radiation.)

I completely agree with addressing known cancer immediately. In my opinion, actively watching cancer grow in your body is a very dangerous option. Current technology does not have the ability to completely track cancer - Any doctor that says they can 100% surveil the cancer without any chance of metastasis is obviously overstating his/her ability. If you have other life limiting comorbidities, active surveillance may make sense. But for those that want the best chance for a PC free life, actively addressing the cancer makes the most sense to me.

Best of luck to everyone with their decision,

Jim

I agree thanks.

I’ve seen people watch it for many years without pc ever spreading 14 years it’s on a video on pc.org

Yes I was 3+3 but after surgery turned out I was really 3+4 I also scored 93% on decipher test so glad I had surgery. 59 and presently cancer free. 7 months post surgery