Surgery or SBRT PSA 4.4; T1c.

If you have SBRT, you should try to have MRIdian SBRT (or equivalent) because it has a much narrower beam that is less likely to damage close tissue. It also has the ability to stop if you move and start again when you’re back in the right position.

Your cancer does not appear to be aggressive, you can have either surgery or radiation or a few other types of treatments like Focal Therapy, NanoKnife, cryotherapy, HIFU,, TULSA-PRO, etc. might work for you check with doctors get a second opinion. You’ve got a very slow growing cancer.

From what you say, after surgery, you will probably have erectile dysfunction. Most people don’t have long-term incontinence, There’s a wide variety of issues. I had no incontinence problems after surgery, it is possible. I did have ED.

There are many ways to fix the erectile dysfunction problems. They have pumps and pills and injections, one of them will probably work for you..

If you have radiation, you will probably still be able to get an erection, At least for a while. The results are all over the place as usual. For myself, I started having incontinence problems about five years after having salvage radiation, I have found ways to keep it under control.

There’s a concern that 10 or 12 years after radiation other cancers could appear on other organs near the radiation. That’s another reason they like to use it when people are older.

It is not unusual for someone to need salvage radiation a few years after their surgery. Some doctors recommend just zapping any metastasis found with a PSMA pet scan, At the latest PCRI conference, they said that only 1/3 of recurrences are handled by salvage radiation.

Just some things to think about. Best of luck.

I was 70 last year when I had NS RARP. I was 3+4=7 T2c with a very bad family history. The pathology of the prostate after surgery revealed cribriform and IDC, so I was pretty glad I had surgery. No incontinence and mild ED which is very slowly getting better. For you I have no idea what would be best. Here's some thoughts to consider: 1) get a decimeter test (or something similar) to see how aggressive your cancer is as that information will probably influence your treatment options, 2) get a 2nd reading on the biopsy tissue sample to see if they concur that 3+4=7 was really found as that also will influence treatment options 3) consider getting a 2nd opinion from an NCI recognized Cancer Center of Excellence (CCOE). If an option for you, consider getting treatment at a CCOE. I'm not a medical professional and I certainly don't know, but personally I consider the skill of the team treating prostate cancer is probably more important than the treatment chosen. 4) Buy Dr. Patrick Walsh's Guide to Surviving Prostate Cancer Paperback – October 3, 2023. It's on Amazon and it's about $20. It really helped educate me on some key points in my decision making and it's organized so you can easily dive into the sections most relevant to your situation. Just my 2 cents. Best wishes.

Yes, both ways have pros and cons and actually almost the same just in reverse order. It all also depends of age, personal health issues, lifestyle and personal preferences.
Results greatly depend on the skill of surgeon or radiologist. The only advantage of prostatectomy is that after prostate is out of the body and completely examined one can get complete and correct picture about gleason and possible breach (as you can see from previous post).

I would also recommend Walsh's book, it is easy to understand and explains many things in detail.

Surgery will give you a detailed pathology report, as mentioned above, which could be very useful down the road. We had NS RARP in 2008 and the pathology was not as in depth as is done now. but even at that, the surgery pathology upgraded the Gleason in our case - biopsy said mostly G6 and some G7 and pathology was opposite, giving a G7. The side effects of incontinence or ED feel like a crapshoot, to be honest - maybe that has changed, but incontinence usually is temporary from others we have talked to, any ED needs attention/effort. Its a tough decision, as we will never know about the choice we don't make, right? All Best.

Thanks for your suggestions. I did read about the MRI guided SBRT but the radiologist said the results from the SBRT Cyberknife are comparable. I would use the space OAR gel to space out the other organs. There is no MRI guided SBRT near my home. I seems most are at univeristies.
There was no mention of future cancers. I did read where men have no ED after the procedure but after 1 year plus ED could happen. That is confusing. He stated if you have any urinary issues (which I don't) such as painful or frequent that SBRT is not recommended.
For surgery I am afraid of not much nerve sparing since all 12 sections are positive.

I was remarried just 5 years ago so ED is important to me, as well as incontinence which is why i lean toward SBRT but if the positives are only temporary, I am not sure now.
I really don't want to be wearing a pad or Depends for years to come.

Thanks for the reply. No one mentioned a decimeter test. Are there problems with the biopsy results at times?
I had an MRI and CT scan as well as the biopsy.
There are not CCOE close by. I have seen a urologist, surgeon, radiologist, and a urologist oncologist. The surgeon is highly known in this area and does most of the RARP in Northern Kentucky. We met with him for 45 min asking all the questions I could think of.
I am somewhat unusual since low intermediate by all 12 sections positive
I ordered the book. It will arrive tomorrow.

Thanks for the reply.
When examining the removed prostate are those result different than the biopsy in many cases?
I assumed that between the MRI, CT, and biopsy that any breech would have been confirmed?
I have the book on order

There can be up and downgrading after the pathology. If you are statistically inclined, think of the Biopsy as an underpowered random sample since it is only N=12. So things may change once you can examine the entire prostate.

I have spoken to at least a dozen people that have had their PSA rise after having their prostate examined following surgery. It seems to be very common, Happen to me too.

In one case it actually was reduced so results may vary, just not very often!

The thing is the cyber knife results are not equal. They can bluff you into thinking they are, but there is a Significant difference In the width of their beams and nearby tissue that gets touched. You can spend a few minutes looking into it and will find that is what the facts are.

If you had to go a distance from home to get treatment you could get free housing with multiple different groups that help cancer patients with free hotel rooms when they are getting treatment. It would be a maximum of 5 treatments if it hasn’t escaped the prostate.

Yes, ED could happen some time after Radiation. At worst, you could use Trimix, An injection into the penis gives a solid Erection. If you are on ADT, your desire for sex will be greatly reduced, which may be more of a problem?

Incontinence problems are something that many of us live with. There’s no way of knowing how your body will react to surgery or radiation, There is so much variation, but frequently a little leaking occurs, I don’t think there’s anything they can do to reduce the chance of problems, maybe the SpaceOAR can help a little, but it is designed to protect the rectum. There are things you can do when it is a problem. There’s a couple of different pills that help a lot if you just leak a little no, Gemtesa and Myrbetriq. And there are a few different other techniques urologists use. One of the latest (ProACT) surgically inserts a couple of balloons around the bladder neck,, they can remotely increase and decrease the Pressure to end the leakage.