Diagnosed

Hi,

At 3+3 you have time to decide on AS, Surgery, or Radiation.  It's really up to you and your family to decide based on the risk of surgery vs radiation.  Do you homework, discuss with your family and decide.  I had surgery and don't regret it.  I am 7 yrs. out since surgery with undetectable PSA.  Just drip a drop or two now and then and the ED is gone.  Took me about two years of progressive healing. A lot of people have had the same success with radiation also.

Dave 3+4

As suggested above, a T3 MRI would show any lesions.  I had essentially the same biopsy results but two 3T MRI's have shown no tumors large enough to be seen in the images.  Also, I would suggest having genomic testing done on the biopsy samples.  This would show how aggressive the cancer is and the probability of future spread.  A favorable result with the genomic testing can provide peace of mind if considering active surveillance.  RALP opens up the POSSIBILITY (not certainty) of issues down the road like urine leaking or impotence.  AS has essentially no side effects.  I would also consider getting a second opinion from a second urologist, since your doctor's recommendation of surgery without discussing other forms of treatment seems overly aggressive.  Best of luck.

Geezer wrote in his first post that he would be 'uncomfortable' with the anxieties of Active Surveillance. I understand that. But I will re-emphasize that radiation is an option that should be studied. Anxiety will be an issue after surgery as well as after radiation therapy; it is for almost all of us 'survivors'. 

I cannot disagree with anything anyone has written above.....  Your cancer is minor, and apparantly non-aggressive.  You are approaching 70 years of age.   A/S could possibly keep you treatment-free (and therefore no side-effects) for the remainder of your natural lifespan.  Capsular escape (metastasis or micro-metastasis) is extremely unlikely, such that either surgery or radiation would very likely be curative if you chose either.  That is, you would be 'cured' of the disease, in the laymen's sense of the word.

It seems to me (as you have said this repeatedly) that anxiety regarding the disease is a key element in your decision process.   This leaves surgery or curative radiation therapy.  I will say that my own case was similiar, and your reaction is not universal, but it is fairly common:  knowing that you would not have peace worrying.   We are each made the way we are made.     

R.P. surgery is a serious one.   Recovery will involve some pain, a week or so on a urinary bag, some time for urinary control to occur, and likely E.D.   How long on these varies dramatically .  One psychological benefit of surgery is that the post-removal pathology report will tell exactly what was going on, and very likely can estimate likelihood of permanent cure.  And, within a few months, yor PSA will go to zero, and remain there forever (as long as there is no relapse).

Curative Radiation Therapy (brachytherapy ['seeding']), fractionated RT (almost always IMRT/IGRT) or SBRT ('cyberknife') are virtually identical to surgery in curative success.  There is no surgery required, the proceedures involve no, or very little, pain, and there is usually no recovery required.  Side effects are RARE, but can involve urinary stricture (blockage, easily repaired), colon damage resulting in ulceration, and skin irritation.  Again, all of these are rare today.   After radiation treatment, your PSA will oscillate, or drift up and down, for a period, sometimes as long as a year, until its lowest baseline, or nadir, is acheieved.  This drift is normal, and does not suggest anything, in most cases.  Then, for future reference, this nadir is used to suggest possible relapse, if such occures.

What I sketched for you here is an Overview, very general.   Men will write exceptions to all of the above, but such accounts do not refute the general or statistical truths I have shared.   I myself had RP  (DaVinci) six years ago, and have been well pleased.   Just me speaking here....

I don't remember my numbers now, but my GP suggested I talk to a urologist when a continual rise in my PSA numbers indicated to him a concern of PCa.  I interviewed several urologists and it basically got down to getting a biopsy.  I got it and of the 14 samples taken cancer was found in 12.  Right, wrong or indifferent I wanted the cancer out and did not even entertain a Watchful Waiting scenario.  A good friend a couple of years older than me, I had just turned 72 when diagnosed, had radiation several years prior and told me if he had to do it over again he'd have the RALP.  I read up on both and went with the RALP.  No problems since.  I developed a post-operative infection a couple of days after being discharged, necessitating a return to the hospital for a couple of days but no problems otherwise.  The catheter notwithstanding.  PSA's since have all been virtually undetectable and it'll have been 3 years since the surgery in June.

The decision on a treatment plan will come down to you.  Your question:  #1 any opinions on having RALP with PC as I discribed?  No, if my Gleason was 3+3=6, I would go with Active Surveillance. #2 I know I'm getting old but my energy level seems a bit low as of late. Does/can early stage PC affect energy?  I had no energy level issues and still don't.  My Gleason 4+3=7;  Radical prostatectomy 3/2018.  Cancer undetecatble; fully continent; intimate with wife.  If I were you, I would stick with the AS plan.  This will save you from being nuked or gutted for a while or maybe for the rest of your life.  Good luck on your journey.

I am in the same boat as you...two cores with Gleason of 3+3=6.  I have been on active  surveilance for about two years.  PSA tests every six months and annual biopsy.  Being treated at University of Chicago.