The Battle Begins

@tmestanas91
Did your scans show no metastasic disease? That is good news. It also sounds like you know about other tests like the PSMA. The bone scan is looking at bones (I had that also) and the PSMA is looking body wise for the prostate cancer protein. I had that also (negative).

For me and we can only give you advise in our own experience and what we did. I don't see you mentioning Decipher. The Decipher is a genetic test that will help define your risk level. That will have a lot to do with your options for treatments. If me I would asked for the Decipher along with the PSMA. That gives you a wide range of tests then discuss treatment options.

What you are going to read on MCC is posters saying their urologist favor surgery and R/O favor radiation. My urologist at Mayo sent me to consultation with Mayo R/O. It was my Mayo R/Os that ordered the Decipher, bone scan, and my R/O at UFHPTI ordered the PSMA then UFHPTI discussed their recommendation with me based on all the test done. And that was proton radiation and because my Decipher came back low risk no hormone treatments even though my biopsies said intermediate.

Those that had surgery and reason why can better comment on surgery. Those who went on hormone treatments can also comment better than I on that treatment also. I can comment on radiation and there are many forms of it and treatments. Some are very new. I can send you a recent WEB MD on latest prostate treatments but is so long would suggest doing it on private message. Let me know if you would like me to copy that and post on a private message.
Good luck on your journey with this.

Thank you so much. I will ask for decipher.. no metastatic disease from nuclear body scan ..so yes good news there. Yes please send me the webmd post. Thank you again.

1/23/25
I had the seed implants Then 4 years later the cancer is back.
If I had it to do over , I would definitely have the prostate removed.
That is not a option now because of the scar tissue.
Always ask what your options are and their success rate.

Another option is external-beam radiation (rather than the more narrowly-targeted seed implants). If you have access to a radiation oncologist, it might be worth discussing.

Pro: external-beam radiation spreads a bit, and may catch any undetected cancer cells that have escaped the prostate (which a prostatectomy won't).

Con: because it spreads, external-beam radiation may also cause mild damage to healthy cells outside the prostate, e.g. in the bladder (which a prostatectomy also won't).

There's no safe bet, unfortunately; every procedure has its pros and cons, and none comes with an iron-clad guarantee that all the cancer has been removed. Some people combine a prostatectomy with post-op salvage radiation to try to get the best (and maybe worst, in terms of side-effects) of both worlds.

Best of luck!

Because you had one Gleason nine your Gleason score is 9. The other numbers don’t matter the highest number is what counts.

You should speak to a radiation oncologist to see what they have to say about your treatment and whether surgery would be better. Urologist are surgeons so speaking to an RO balances the information. With a Gleason nine other treatments are usually not available.

Are you working with a center of excellence? Going to one would allow you to have multiple doctors getting together and deciding what would be best. Because you have a Gleason nine you might want to get ahold of a Genito urinary oncologist to guide your treatment, they specialize in prostate cancer, unlike medical oncologist, who treat all different types of cancer.

Did they find cribriform or intraductal in your biopsy?

Thank you @jeffmarc for clarification.. I’m a rookie. I didn’t see mention of intraductal or cribriform.

Hey TM91, Could you please tell us your age? Sometimes it is a huge factor in which treatment you select.
Gleason 9 is considered aggressive; paired with a high Decipher score could be an indication of an even more aggressive disease. But even a lower Decipher score (below .5) does not mean all that much once you are a G9.
All the specialists - radiologists or surgeons- will tell you that your disease has a higher chance of recurring than in someone with a Gleason 6. With that in mind it is usually recommended that you go with surgery as your primary treatment; if your cancer recurs, it can then be treated with radiation and hormone therapy (ADT).
The reverse, radiation first and surgery later, can also be done but is much more complicated due to radiation scar tissue and only a few highly specialized surgeons do this.
The reason I go thru this long winded spiel is this: if you are young - mid 50’s to low 60’s - surgery is probably the option I would choose (and did). If you are in your upper 60’s or older, or in not such great health, radiation becomes more attractive simply on an actuarial basis - how long you might live - or die from something else before your cancer returns.
Yeah, it’s somewhat dry and analytical but that’s how you have to think when making these important choices. As stated, I was a Gleason 7 unfavorable and chose surgery because of its chance to recur. 5 years later, it did, and I just completed radiation and ADT treatment with fingers crossed. So I got my second chance and hopefully will not have to try for a third🤞. Best of luck!
Phil

Hi Phil: @heavyphil Thanks for your comments.. I’m 61 yrs old. Fairly fit good health otherwise.. so far I think the surgery is the recommended path .I have the psma test in 2 weeks. Bone scan was good. 🤞. Thank you for your insights and I hope your new regimen keeps you healthy.

Nothing much to add to the discussion - just wishing you the best in whatever course of treatment you choose.

@timestans91
I went to private messages and tried to copy the web site information and article but just kept giving me the round circle. Maybe was too long.

You can log on to WEBMD.com for the article and even join (free) at: WebMD.COM

The article I was mentioning is "The latest advances in Prostate Cancer Treatments.

It is an excellent article. I am a member (free) and get these special articles every day. You can also go to Mayo.Com and ClevelandClinic.Com as they also have excellent information and specific forums.

I did try but guess too long an article to send on private message.