Posted 1/30/2025 8:51 AM (GMT -5)
Hi gold horse. The choice of primary therapy is often personal one, but should be based on the entire diagnostic workup: Is his G8 the typical Gleason (4+4) or the less common, but more serious, (5+3)? Is there evidence (e.g. CT, PSMA-PET, bone scan, PSA history, value and rate of rise) that the cancer is probably no longer prostate-confined and, if so, where is it thought to have spread--locally or metastases; if mets, pelvic nodes or distant mets? Would a genomic test (e.g. Decipher) be helpful in decision-making, especially regarding ADT being part of his primary treatment?
The choice for surgery could be influenced by the chances that it alone has a fair chance of being curative, or will his workup show that surgery would probably need to be followed by radiation/ADT after a healing period as part of his primary treatment?
IMO your cousin would be better off "polling" (i.e., consulting) specialist doctors (urologist, surgeon, R.O.) for his specific case rather than Forum members. Should a consensus of his doctors/consultants for either surgery or radiation outweigh a strong personal preference for the other choice? Often patients are told that the treatment decision it up to them and that they need to choose between surgery or radiation. But not always.
Djin