Radiation vs. Prostectomy (nerve sparing)

Your 3+4 Gleason Looks pretty good. The issue is that UCSF had a seminar where they discussed cribriform. They said it made a 3+4 have a five in it. And that sort of syncs up with your decipher score of .72 which is pretty high and bodes for a reoccurrence at some point. They also said that SBRT radiation isn’t effective with cribriform.

I had a 3+4 at 62. I decided on surgery because my father had radiation and died from prostate cancer. After surgery, they said my Gleason was a 4+3 . My PSA started rising after 3 1/2 years and I had to have salvage radiation. It started rising 2 1/2 years after that and I had to go on Lupron. I’m still around 15 years after that surgery, The drugs they have today work quite well. I have A genetic problem BRCA2, So that’s why it keeps coming back. There was no decipher score when I had surgery 15 years ago.

While you have cribriform in more than one place It doesn’t really say whether it is large cribriform. That is much more aggressive and maybe is why your decipher is so high. You could ask them whether it is large or not.

Surgery is much more effective if you have cribriform, because if you have a reoccurrence (Which your decipher says is likely), you can have salvage radiation. If you have radiation to start with, you can’t do that. If you have surgery, you want to make sure you talk to the doctor about sparing the nerves, That can allow you to get an erection after surgery without using drugs that have to be injected.

Getting an hereditary, genetic test is a good idea. If you have certain genetic issues, there are new drugs to treat them. You can get one free here
http://Prostatecancerpromise.org
They will send you a spit tube and in about three weeks a genetic counselor will call you to discuss the results. Don’t check the box to have your doctor involved. In that case they won’t send anything until they speak to your doctor.

Much of what Jeff posted lines up with what my doctors all told me: if you are able to get surgery then do that first and leave radiation on the table for recurrence down the road - if there is one. When done in the opposite direction, surgery becomes "salvage surgery" where they just scoop out the goo left. I was 3 +4 and Decipher 0.68, but no cribriform, otherwise I'm quite similar to you and, at 54, I opted for surgery.

In 2006 I had 25 IMRT sessions followed by seed implantation of 66 Iodine 125 radioactive seeds.
In 2009 I developed a recto-urethral fistula requiring an Ileostomy. In 2014 my urethra scarred over completely resulting in a suprapubic catheter. Surgical repairs for both are not feasible because of the radiation damage.
I agree with the commentators who suggest surgery first and radiation if needed.
When I was in your position I spoke to as many men as I could about their experiences. At that time (2006) none of the men who had surgery were satisfied with their results.
I understand surgery has improved immensely in the last 20 years.
Good luck.

Thank you, Jeff. I really appreciate the insight, advice, and all the work you put into helping people on this site.

I chose Radiation vs removal but specifically an MRI guided radiation machine as there are different types of machines and only two that have a built-in Mri, the Elekta Unity and the Mridian. That meant less healthy tissue exposure and less chance of side effects and quality of life issues.

My Gleeson was 3 +4 with an 11.2 PSA and a low decipher score. I had five hypo fractional treatments in February 2023.. no issues so far.

Jeff tells everyone a lot, but never tells us his current Testosterone level- it’s his secret. Lol

Thank you. I understand my facility (Tallwood Men's Health Hartford Hospital) uses the same technology. I also have cribriform which I understand from this blog (Jeff M especially) and my doctor's my higher decipher score. I appreciate the insight. I have talked with a few guys here that I have gone through radiation and each has similar results when diagnosed with Intermediate Prostate Cancer (contained).

Thank you. I understand my facility (Tallwood Men's Health Hartford Hospital) uses the same technology. I also have cribriform which I understand from this blog (Jeff M especially) and my doctor's that this is root reason of my higher decipher score. I appreciate the insight. I have talked with a few guys here that I have gone through radiation and each has similar results when diagnosed with Intermediate Prostate Cancer (contained).
Best wishes to you for continued Success.

I cannot advise you on the choice before you. In general (not you necessarily) the results are equal for the two methods. I have read that the Higher Risk category gets the nod for radiotherapy versus surgery.

At 72, my choice was prostatectomy.
G 9 pre and post-op; with EPE added by post op pathology.
Pre-op PSMA PET scan did not indicate spread.
I wanted to take my chance for a cure by surgical removal of all the PCa.
Disappointedly, but not shockingly, my PSA was a persistent .19 90 days post op.
Salvage Radiation Treatment was initiated consisting of 4 mos ADT and 37 IMRT radiation treatments to WPRT, including 25 to the pelvic lymph nodes.
Post treatment, my PSA has been undetectable at < .02 for 2 years.
And I would do it again.
The radiation option was not attractive to me, although there are many who have been satisfied with that choice.
Sincere best wishes for a successful treatment.