Recently diagnosed Gleason 7 (4+3), psa 16, evaluating IMRT / IGRT vs surgery

I am 79 yr old diagnosed Oct 2021 after PSA of 4.26. Biopsy showed 4 of 13 cores with PCa with Gleason 7 (4+3). Thought I wanted robotic prostatectomy but MRI showed cancer in one seminal vesical and neural vascular bundle on left side which placed me in the unfavorable high risk group. Urologist recommended against surgery and referred me to radiation oncologist who did one of the most thorough physical exams in my life--prescribed 45 IMRT and ADT (Lupron 90 day shots) for 18-36 months. Started on Lupron Dec 22. 2021. Had fiducial markers and SpaceOAR placement under anesthesia at local hospital (none event) March 11, 2022. Had 44 IMRTs from Mar 29 to May 27, 2022 with no missed appts. The radiation during the last phase when it was focused on the prostate irritated the heck out of the urinary system for a while but no long term side effects. The biggest problem with IMRT was timing the full bladder with empty colon before each treatment. By Sept 20, 2022, 3 months after radiation, PSA down to <.06 and testosterone at <7--both undetectable. Had no significant physical damage from radiation other than urinary urgency which existed prior to the radiation. The only side significant side effect from the Lupron was ED which started on the 30th day after the first shot. Some slight warmth but not what I would call a serious problem with hot flashes. Will have my 6th Lupron shot in April and am negotiating with the urologist and oncologist about going on intermittent ADT. Overall, I believe that I have had a very good outcome from my IMRT and ADT regimen. I am glad that the urologist recommended the radiation regimen instead of doing surgery to be followed immediately by a program of radiation and ADT because of the cancer outside the capsule.

Here’s my take I don’t know how old you are I’m going on five years now I was 56 when diagnosed almost the same as you except my PSA was seven. It was the biggest hardest decision of my life I was very very confused I saw way too many doctors but the bottom line was this I was afraid to have surgery and that is what stop me I decided to go with the radiation treatments and then a booster. It did work out for me the only side effects I have or I have to take Flomax because I have a blockage in my urinary track but if I had to do it again I would’ve just had the prostrate removed and been done with it to me it’s simple it is localized do you have three options one get the best surgeon I have a surgery done enough all goes well which most likely it will you are done sure you may have other side effects but you’re done if it comes back then you can have the option to do radiation treatments and then if it comes back again you have the third option which is yeah absolute worst hormone treatments. The reason I say this is because I skipped step one don’t let them tell you you can have surgery after radiation because you really can’t it’s very very dangerous they made it seem like I could and that’s not true so now if it comes back I could do radiation treatments again but doing that twice would not be good at all I would most likely be set myself up for cancer definitely later on and then I have to do hormone treatments and I would be screwed so if you want my opinion sure radiation treatments I guess work but you know what I know three men that have had prostate cancer after my diagnosis all of which had surgery and all of them are fine so there you go that’s just my opinion I wouldn’t think twice again I would get it done and get it over with but by the absolute best surgeon