Received the news on Halloween. I have prostate cancer. Need advice.

It’s good that you’re in information-collecting mode. That will guide you towards an appropriate decision.

> It’s always a good idea to get 2nd opinions on biopsies — not necessarily because you don’t trust the 1st one or don’t like that opinion. But, because much of the interpretation of images and scans is often as much an art as it is a science, and it’s dependent on the skill and experience of the person reading the slides. It’s good to have an independent set of eyes reviewing the biopsy.

> Since you have a “4” cell type in the Gleason score—> In the MRI or biopsy reports, were the words cribriform pattern, extracapsular extension, seminal vesicle invasion, perineural invasion or intraductal carcinoma mentioned? (If not, that’s good.)

> also, ask them to calculate your: % Free PSA, PSA Doubling Time, and PSA Density to see if those are ok or if they indicate any concern.

> the genetic (germline) test will check a few dozen markers that may be related to prostate cancer in addition to BRCA1/BRCA2. (See attached chart for the key markers.)

> I would also ask to bump-up PSA testing to every 4-6 months rather than annually (and calculate those three - % Free PSA, PSA Doubling Time, and PSA Density - at every PSA test). Tracking PSA more actively going forward is important.

@heavyphil
Thank you for your thoughts. I was indeed born in 1956. I will be 70 in 3 weeks.
I was diagnosed with Stage 1a lung cancer early this year. After a surgery to remove one lobe, I am now in remission. I have to do a chest CT every 6 months and no other treatment. The one right before my prostate diagnosis was all clear but lung cancer has a lot higher recurrence rate than prostate cancer.
Going thru another surgery is not something I would want to do. I just want to tame my prostate cancer before I had to deal with lung cancer in 2-5 years. I may indeed die from something else than prostate cancer, as they say.

@frank1956 How old are you Frank? 70ish is really the grey area if your handle ‘1956’ refers to that.
PCa is tricky and sometimes even with all the boxes checked off , it can come back. The forum is full of us in our second, third and even fourth go rounds.
Radiation may be an excellent choice for your condition, but - and this is purely speculative on my part!- if your cancer returns and you are still hale and hearty in your late 70’s or early 80’s, you WILL need a backup plan.
Sometimes, even though it sounds distasteful, surgery is an excellent treatment as well (possibly curative, as is radiation) but offers the dividend of being able to do radiation down the road if necessary. To do the reverse - radiation first and surgery second - is not frequently successful.
Just food for thought as you navigate your way through these confusing stats, outcomes and recommendations.
Best
Phil

I am the OP.

It took a while to get the other test results in. My Decipher score is 0.57. Intermediate risk, very close to the high risk area of 0.60. PSMA shows the same 2 legions inside prostate, but no where else. I also did a Color Health saliva test that shows negative of all 29 cancer genes they tested.

I met with my UCLA Urologic Oncologist. He said due to my high Decipher score, he does not recommend Active Surveillance. I asked for referrals. His office set up appointments for me with Dr Kishan on Jan, 9th, 2026 for Radiation consultation, and Dr Reiter on Jan 21, 2026 for surgery.

My Oncologist said wait for another 3-4 months is probably OK since the actual treatment may be months away. Meanwhile, I am doing a lot of research on SBRT and Brachytherapy, but I need to talk to Dr Kishan first so he can evaluate me for best modality. Though I have an appointment with the surgeon, I am really not sure about surgery. If Dr Kishan's consultation can give me confidence, I might cancel the appointment with Dr Reiter later.

@cward0624, welcome. Did you consider other treatment options or was surgery the clear choice for you? What type of surgery will you be having? How are you doing?

3+4 is not life threatening. Basically, just keep an eye on your PSA. Any significant increase in that number beyond 6 and you will initially be put on hormone treatment to stop your testicles producing testosterone which cancer needs to feed on.

In same boat waiting to set up surgery .