Would you recommend proton therapy vs surgical removal of prostate?

@seekingclarity thanks for this post and the great questions. I will be following this thread as I am in a very similar situation, but a few months behind you. I had my first biopsy on 12/2 and it showed two G6's and one G7 (3+4). I am still waiting on my decipher results. I'm 57 and am going to take the next several months to research my options (surgery & if so where, tulsa pro, ongoing active surveillance, etc.), unless the decipher results indicate something potentially more aggressive than the "favorable intermediate risk" the dr. believes I currently have. To your question about PSA results, like the others have said, I think they consider it more of an indicator and not necessarily anything definitive. Also, it is quick, easy, and cheap, so it makes sense that the doctors would start with PSA. After several elevated PSA readings and a negative MRI a few years ago, my dr. recommended Iso PSA, which ended up being unusually high. From there we went to an MRI which was pirads 4, and most recently a biopsy with the results above. I think this is a fairly normal progression, even though I'm on the younger side. The one redeeming fact about prostate cancer is that it's fairly common and also usually slow growing. There's a lot of data out there, and most of us have time to weigh options and make decisions.

https://www.urotoday.com/conference-highlights/eau-annual-congress-2023/eau-2023-prostate-cancer/143058-eau-2023-15-year-update-protect-trial-part-i-oncology-jenny-donovan.html
https://scienceinsights.org/what-the-protect-trial-reveals-about-prostate-cancer/
https://pubmed.ncbi.nlm.nih.gov/36912538/
Given your age and Gleason score I would just monitor. Research the Protect T trial and others

I had HIFU done 7+ years ago. I recommend that over surgery or protein treatment. The cancer has to be localized to the prostate. No problems since or before, as a matter of fact.
My best for a good remedy.

I had HIFU done 7+ years ago. It worked for me. Luckily, I’m close to one of the few locations on the East Coast that does that. Minimally invasive.

@tuckerp
Great information for those on MCC. I hope your post confirms that just having a low normal PSA does not mean you don't have cancer just as much as a high one does not mean you do.

I thought my journey with PC and having a 3.75 PSA and having cancer was uncommon but your post of having a 1.1 PSA shows it can and does happen.

I hope you had a good outcome on your treatment.

@jc76 good explanation. Thank you. As you mentioned PSA is just a number. Mine was 1.1. No increase from previous. I had cancer.

@jc76 Thank you for the discussion points to think about. I haven't included everything yet just some of the basics I read from my biopsy. Please note I will do a follow to include more of the information from this being my second biopsy which this time was transperineal vs my first one 9 mths ago was also 3+4=7 and a decipher study was done as well. My most recent one posted 3+3= 6, 3+3=6 and then a 3+4=7 which I believe is the decipher portion. I will look at the percentages. Although I recall of 4cores taken 30% reflected PC if I read it right. So I will follow up with more details by tomorrow. I have a follow with my urologist on the 22nd and R/O on the 31st

@neilmartin totally agree. Tried to reply to the author but these forums are not my cup of tea.

I would add that he needs to get with his doctor and a Medical Oncologist specifically to understand options. His Gleason score unless there is escape, wouldn't automatically mean having a radical prostatectomy. Lots of potential options.

In the end, I formed as best as possible the treatment option chosen is a function of many many things. Not a yes or no thing.

@seekingclarity
If you are going to have PC your numbers are what most of us would like to have. Does that help?

Regarding PSA. It is not an indicator of having cancer or not having cancer. It is a test that indicates prostate issues which can be cancer, BPH, infections, etc. So that test indicates a need to, or not, to do more testing.

Having a high PSA does not mean you have PC nor does a normal PSA number mean you don't. What is important is if there is increasing climbing PSA numbers, a very high number, and/or you have symptoms. With PC it is the increasing PSA numbers over time that were my caution light not my PSA number.

In my case my PSA was 3.75 when diagnosed with PC. So it is not just a PSA test that can diagnose PC. My PCP was concerned with rising PSA numbers over time (I had no sypmtoms of BPH) and referred me to urologist who did a MRI with contrast and then a MRI/Fusion biopsies which confirmed PC.

You had only 1 score of 3+4=7. Look up what Gleason scores mean. The most concerning number is the 7 but where the numbers are 3+4 or 4+3 =7 do mean different things. The 3 listed first means most of the biopsied is at a 3 versus the 4 first as being most at 4. Bottom line though is have a 7 indicates issues with abnormal prostate cells indicating PC.

From your post I do not see your doctors discussed with you the Decipher test or the PSMA test. Both of these test can really fine tune your diagnosis and help with any decisions you are your doctors need to make.

I list the above information from my Mayo urologist, R/Os at both Mayo and UFHPTI. I was shown graphs that explained what I posted above so I am posting information directly related to my experience with PC.

At the level of your Gleason score you have so many different choices of treatments. You need to discuss all those options with your urologist and R/O if you referred to them. Ask the pros and cons of all and then do your own research on major medical instutions like Mayo, Cleveland Clinic, John Hopkins, etc.

Ask your doctors about getting a Decipher test which is a genetic test to give you a more accurate result of your risk level than a Gleason Score can give. A PSMA would determine if any cancer has moved outside your prostate.

You are at the beginning of your journey. Know that only you and your doctors know your full medical and mental health history to diagnose, and give your treatment options. If you have doubts get second and third opinions. Many second opinions can be done merely by sending your medical records to another medical facility.

@seekingclarity Have you had the biopsy done outside of the genetic (negative) test results.