Welcome to the forum. You appear to be relativity low risk so many treatments will give you great cancer control. The various forms of radiation rarely fail locally and all have good and effective salvage methods. Please don't fall into the "if my surgery fails I can use salvage radiation but if my radiation fails I can't then do surgery". This is a red herring that too many urologists give to convince you their surgery is best. And it simply wrong.

SBRT/Cyberknife, HDR brachytherapy, permanent seed brachytherapy all are as good or better than surgery and leave you with much less severe side effects. I strongly suggest you visit several radiation experts nefore you finalize your treatment decision. Do not let your urologist advise you on radiation. That is not their speciality. You have plenty of time to make a great decision and you will get a lot of great information here

Best wishes

Welcome to the site!

Congratulations on 3-years of successful AS. There have been big strides in PC treatment over the last several years, and you get to reap the benefits of them all!

You might also be interested to know that a "Level-1" (highest quality) long-term study was just published which says that as far as cancer-specific mortality of localized PC cases (like yours), it doesn't matter which treatment mode you choose: surgery, radiation, or surveillance...they are all statistically the same. So, choose away! Good summary of the findings at this great PC information site, "The 'New' Prostate Infolink Site." Go here: /prostatecancerinfolink.net/2016/09/15/the-initial-10-year-results-of-the-protect-trial-much-as-we-might-have-expected/

What may actually be more interesting to you is the report that was written in parallel to the study I mentioned above which addresses the Quality of Life (QoL) of the patients in that study. Go here for that article: /prostatecancerinfolink.net/2016/09/15/patient-reported-outcomes-and-quality-of-life-in-the-protect-trial/

Kudos to the authors of this study for realizing—20 years ago, when they first started planning this study—that men in the future would be interested in comparing cancer outcomes and QoL outcomes for surveillance vs. surgery vs. radiation therapy for localized PC.

best wishes

Welcome RTaylor-

You had a good run with active surveillance, and I'm sorry it had to end.

I just wanted to address a comment you made. You wrote, " I looked at radiation but concerned about options if it comes back. "

There are many salvage options if it comes back, including salvage focal brachytherapy, focal ablation, and whole gland SBRT. Even salvage surgery has decent outcomes in the right hands, but I agree that it's seldom the best salvage option.

I think it's a good idea to visit with the various radiation specialists before you take what you may have heard from a urologist as truth. If you say where you are, we might be able to recommend specialists.

BTW - a small error in your signature. you wrote 3+4 when you meant 4+3 (or vice versa. You wrote:"...when one my cores came back at 4+3"

Hi group,
Thanks for the comments and new information.
Yes Tall, My mistake. 5 cores of 3+3 and one of 3+4. One issue I did not mention is that I have had two procedures that left scare issue in my penis. Urologist is a little concerned with radiation.
So hate to ask this questions but need to. Does the penis shrink after surgery? Some have said "who cares, life is more important" but they are not the ones dealing with this. Thanks

BTW - most active surveillance protocols allow men to go untreated until the Gleason score hits 4+3 (not 3+4). But you may decide to have treatment in spite of that, of course. You should also get a second read from Epstein at Johns Hopkins on those biopsy cores.

The radiation field does not include the penis. In fact, they take care to preclude radiation from even the penile bulb deep inside. Your urologist obviously knows little or nothing about all this - you have to talk to a specialist.

Yes, penile shrinkage is a common side effect of surgery. Other sexual side effects that may occur (beyond loss of erectile function) include climacturia, Peyronie's, and dysorgasmia. If you already have scar tissue on your penis, Peyronie's would be a major concern.

RTaylor,

Your statistics are very similar to mine. I was diagnosed GS 7 (3+4) at the age of 60. I decided to have daVinci surgery for several reasons. First off, I wanted the darn thing out, I wanted to see a final pathology report, and lastly if it fails I can do radiotherapy.

FYI, my surgery went well. I could have returned to work after 2 weeks, but I stayed out for 3 weeks. I was fully continent on removing the catheter 10 days later. And as for ED, never was a problem even several days after surgery before I had the catheter removed Willy was standing during the night.

I did have positive margin which required me to undergo IMRT/IGRT two years later. Again, the 39 sessions were a non-event. No gastric or urinary problems during or after radiotherapy. Maybe slight fatigue towards the end of radiotherapy, but if it did occur it was very manageable.

Do I have any regrets on surgery. Hell no!

Nick

Hello RT and welcome to our world. Sorry you got the upgrade. My first thought is that I would probably still want to continue on AS if I could. That said, if the 3+4 is weighing too heavily on you, then I can certainly understand why you'd want treatment. But I certainly wouldn't consider it a must have. (Oh, and I agree about the second opinion on your slide...if it comes back a 4+3 you definitely want to treat. But...hey, what if it comes back a 3+3?)

My second thought is that while surgery has an excellent chance of curing you, so do various radiation treatments and it would be a shame to settle on surgery without checking those out. And asking your urologist about the radiation is sort of like asking a Ford salesman if you should buy a Chevy. I'd really try to find the best radiation oncologists ask about their treatments. If you do your due diligence and land on surgery, then good for you. You've made up your mind with full knowledge of all your options.

Most of all, good luck to you. You've already been down this road somewhat with your initial diagnosis and I'm sure that even AS hasn't been easy. I'd just say to keep all your options open and learn as much as you can before making a final decision. And we'll help in anyway we can no matter which way you go.

RT - I agree with Tall Allen - your urologist is typical of urologists. His knowledge of radiation therapies for PCa is out of date. With the modern delivery systems, the radiation oncologist can avoid radiation to areas outside the target zone, down to sub-millimeter precision (with SBRT like CyberKnife). I would strongly advise you to investigate these therapies before committing to surgery.

Do not underestimate the magnitude of this surgery. My uro/surgeon painted the rosy picture of his patients who are only in the hospital overnight and who go back to work in two weeks, but he did not say how young these patients were. I guess when surgery goes well, it goes really well. . . but when it goes badly, it can get really bad. The older I get, the less I want to have any more major surgery if there is a non-surgical treatment that has the same efficacy for me.

Very sorry about your friend with seeds that had the recurrence. While I don't know the specifics about how aggressive his cancer was, if he had had a recurrence after seeds it most likely means the cancer was outside the prostate. So if he had had surgery, he also would have had a recurrence.

Also, keep in mind that as a 3+4 (pending the Epstein review), you're unlikely to have cancer beyond the prostate. This is not meant to talk you out of surgery--it's a valid treatment for your diagnosis. But surgery is not less likely to give you a recurrence. Consider this: if any of the treatments have an equal chance of curing you, I'd be looking at what the SEs of each treatment are and making my decision based on that.