What would you do?

Although the (2022) TURP procedure showed you had cancer, I think that a biopsy is needed to find out more about the current status of your prostate. How many lesions etc. I agree with jc that an MRI would be an excellent starting point, prior to the biopsy.

Hello @Salty5, here's my 2c.

Gleason 3+4 is pretty normal at time of diagnosis but despite that, your PSA is actually below normal range for someone your age. Your PSA doubling time is somewhere near 24 months; a doubling time of 3 months is panic stations, and a doubling time of 9 months is the usual indicator to intervene immediately. Roughly speaking.

I would like you to consider this: Your cancer is present but not overly aggressive now. Let's suppose that it might turn nasty in a year or two and it might need some sort of intervention at some stage after that. Who's to say that by the time you are in your late 80's you wouldn't lose sexual function anyway? Don't take this the wrong way, but it seems like you value your sex life higher than your actual life. You are in an enviable position. For someone in your situation, your potency is a bonus. May as well keep enjoying it knowing that it could end anytime naturally anyway!

My completely uneducated assumption is that you are the guy who will die with, not of, prostate cancer. Serious question - what is your life expectancy? If your target is 90 for instance, it's probably not worth treating your cancer now if the potential side effects are unpalatable to you. But it is definitely worth continually monitoring your cancer with regular PSA blood tests and scans; at least it will give you options. Keep going with active watching!

how was your TURP .. did you have LUTS lower urinary track symptoms. How was the procedure and the recovery and what symptoms where u having and have they resolved due to the TURP.
Interesting your psa’s are so “normal range” and you have a Gleason score of 7. And they know this from prostate pcs they captured during the TURP procedure ?

I wonder if your TURP gives you less issues and symptoms due to the procedure from treatment. Maybe worth asking?

They did my MRI first instead of dealing with my symptoms .. and since a high pirads score the focus moves towards a diagnosis of cancer or not .

I’m just in my early 60 waiting on my biopsy results, and dealing with these persistent urinary track issues .

I would not expect an MRI prior to TURP without an elevated PSA.
Now that you have the diagnosis of prostate cancer at 83 years of age and your doctor is suggesting treating it, I strongly encourage you to get an MRI. If there are no significant PIRAD lesions then you have T1a or T1b disease. You may do very well with observation only. It should take 10 years for your prostate cancer to become problematic, you will be 93 years old in 10 yrs.
If you do have significant PIRAD lesions then a biopsy seems very reasonable and you will make a more informed decision about follow on treatment such as radiation.

Just my two cents,

jc

I think that makes sense!