newly diagnosed and confused already

[KwajMike]

I'm 59 and was diagnosed two months ago. PSA of 7.7, two cores positive at low volume (5%) with a gleason of 3 plus 4. I've been doing my due diligence over the last two months with a lot of internet research, meeting with surgeons and radiologists and talking with folks who have gone thru this. Was leaning towards surgery and then leaning towards radiation. Just had a follow up PSA and it has now doubled to 13.9 in four months whereas before it was very slow growing. My urologist wasn't overly concerned other than to say I was no longer a candidate for active surveillance. Rather than taking my time I now feel like I should choose between either

surgery or radiation based on whichever one I can get done first.

[KwajMike]

Thanks Bob, very happy to hear about your outcome. Did you consider radiation at all? Have side effects from surgery been much of a factor for you? How long ago did you have your surgery?

[ffiore]

Mike, first of all, did you get a second opinion on your Gleason score. Have it sent to a known credible source like Dr. Epstein. Second, a lot of things can affect the PSA score. Did you ride a bike or have sex of any kind in the few days before your test. An infection in the prostate can also raise the scorer. Then if you have nay kind of urinary tract infection, it could also raise the PSA score. All these happened to me and my PSA bounced around from <1.0 to 8.0. A Gleason score of 3+4 is considered lesser risk compared to 4+3. You have time to make a decision based on your score. Keep taking the PSA test and check to see if any of the conditions I mentioned are present before you take another. And get that second opinion.

[KwajMike]

Thanks and yes I did send my biopsy slides to Johns Hopkins for a second opinion. They came back with the same 2/12 cores positive and 3 plus 4 although the Johns Hopkins results showed slightly less volume ( 5 and less than 5% versus 5 and 10% from the original reading). I don't think I had a UTI and didn't ride a bike and not sure about the sex at that time. In the four months between my two PSA tests though I did change my diet significantly and lost 30 pounds and greatly increased my workout routine. I had a small hope that those changes might help with PSA or at least not make things worse which is why this big leap pretty much has terrified me.

[KwajMike]

Thanks. I have had several DRE's and all have been normal.

[dmt1121]

I am sorry to hear you are facing this set of options. I had a robotically assisted RP in 2016 after doing research on surgery versus radiation. My choice was base on a few decision points. 1. Radiation leaves the option for follow-up (salvage) surgery afterwards very difficult because of the tissue damage. 2. Radiation, though much more precise today than in years past, may still damage the bladder and/or bowel. 3. While radiation would potentially leave one able to achieve an erection, the thought of potentially adding that radiation load to what might be needed later didn't seem like a good trade-off to me. I am not sorry I chose surgery. I have almost no incontinence but sexual intercourse is in the rearview mirror, unless getting surgery for that as well.

For me (age 57 at the time of the RP), it was no contest. I chose what I thought was the best treatment for saving my life and gave up sexual intercourse. Also, keep in mind that ADT (which almost all longtime PCa patient end up on) suppresses testosterone and your libido with it, killing your desire.

Anyway, this is a totally personal choice for you to make but please do your homework and know the side effects and long-term consequences area for each treatment and make your decision based on your goals and the facts.

Good luck!