Need Advice from 7's

I was recently diagnosed by the way of a mri-guided biopsy on Halloween. My score was a 7 because 5 out of 9 cores were 4 + 3. After talking to a couple man who have had proton beam therapy, it seemed like the way to go. However the Irving based proton doctor explained that I would have to be on hormone therapy for up to 2 years. The radiation oncology group at UT Southwestern said one year. Their surgery Department said that they would only suggested it after a rise in PSA postoperatively. And he did say that radiation would be the first line of defense postoperatively. My bone scan and my colonoscopy have been done in the past 10 days and were both clear. I have a January 15th surgery date and realize that radiation is my backup and possibly hormone therapy. I've come to learn that you can't radiate then operate because of the damage it does to the prostate and surrounding tissue. Does anyone have any advice for me? I am a young 67 year old with a 53 year old fiance. I was implanted with a Titan coloplast penile implant and absolutely love it. The shots and pills stopped working for me. I really feel that I want to avoid the hormones if it all possible because of my younger wife to be. Any insight that you guys have would be most appreciated.

Do not believe a surgeon telling you that :"you can't have surgery after radiation' because the statement is misleading by omission. Yes, surgery after radiation is very difficult, and only a few specialists do it.

But, what is more important is that there are several other, effective, treatments available in the case of failed primary radiation.

https://pcnrv.blogspot.com/2017/09/focal-salvage-ablation-for-radio.html

Tebozo - You owe it to yourself to do your research on treatment options before you have any treatment.

One thing to consider is that "having a backup plan" should NOT be the driving factor in your treatment choice process. Having the best chance at a cure and having acceptable side effects should drive your choice. Many of the most common first-line treatments have almost identical cure rates, so the decision becomes heavily based on the side effects. So, in favor of radiation, if your first-line treatment has a cure rate of, say, 93 to 95%, how worried should you be about that backup plan?

Also, DO NOT base your choice on what one specialist says are the efficacy and side effects of another specialist's treatment offering. In other words, do not rely on a surgeon to be able to tell you all about how effective radiation therapy is, or about its side effects. You need to learn those things from a doc who actually practices that therapy. In fact, within the radiation oncology ranks, you can't even expect a beam radiation specialist to be able to fully discuss brachytherapy (seeds), or any other form of radiation that he/she does not offer. And to make it more confusing, you can't expect a practitioner of traditional EBRT (40 treatments over an 8-week span) to be able to fully discuss SBRT beam radiation (5 treatments over a 2-week span).

True, your G4+3 is concerning, but do not let that concern rush your treatment decision. Taking even a couple of months to decide has not been shown to have any statistically significant impact on your chances for a cure.

A significant point, sorry to say, is the difference between 3+4 and 4+3. The 4+3 is higher risk, and many docs prefer to treat the 4+3 as if it is a G8--which means ADT plus a lot more concern for micro-mets--which means systemic treatment, not local.

Surgery might cure you--but with the dominant G4, the odds are against it. Take a serious look at the radiation options, HDR, SBRT, and they might suggest the triple-play option that would include ADT.

"HDR + SBRT + ADT. That's my vote."

i'd second triple play in your case too and add that surgery would be my last choice because there's a chance with your numbers of triple play via salvage treatment anyway, and that way would not be as effective plus you'll have a much better shot at permanent SEs -- i.e. incontinence and ED.

your doctor sounds like prostate snatcher to me. he means well and he's doing what he was trained to do but i just don't agree with the piecemeal approach to treatment.

anyhow take a look at my signature so you know that i speak from experience, and i have the results you are hoping for.

The combination of EBRT/IMRT and brachytherapy HDR if you can handle it based on your health. plus ADT is often recommended for 4+3 to kill all the cancer. Don't be afraid of hormone treatment. If you want to try 6 months verses a year that is better than nothing. However if 1 year was recommend you need to find why you don't need it. You might consult with Mark Scholz https://www.prostateoncology.com/authors/mark-scholz/ You can do it remotely but it won't be reimbursed. There are many others out there that can provide you objective information-experts who won't be treating you. I was going to fly to LA to meet with an urologist in the Schultz group after the MD Anderson Proton Center came back with a 4+3, however this was not confirmed by my 3 other pathology reviews including John Hopkins and my oncologist at MD Anderson didn't even believe the pathology report. The thing is with surgery you may not get all the cancer. Also no guarantee on no erectile dysfunction following radical prostatectomy. I thought from your first post you were a lot younger. I really believe you need to dig into the google research, read as many good prostate cancer books that you can and get all the testing done especially TPen and perhaps other genetic test. Get as much information as you can before making a decision. I changed my mind many times. Good luck!

69 yrs., marathon runner with knee injury, 41 of 44 3D-CRT/IMRT Radiation delivered via 3D-CRT in 1.8 Gy minimum dose fractions to a total of 79.2 Gy., 10.5.18. PSA .012, 8.12.18, 1.42 June 18, 2018 (Lupron 5.21.18 & 8.15.18), 12.7 May 2018, 13.7 Jan. 2018, 2.1 May 2012. SpaceOar 9.6.18, testosterone <.7, 8.15.18, Tot Mayo 19 ng .17 testosterone Free 6.18.18, Gleason 3+4=7 involving 15% of the right apex and 15% of the right mid, 3+3=6 prostate cancer involving 5% of the left base. Pathology interpretations by John Hopkins, UNM Cancer, and SF Path 3+4=7 or 4+3=7 MD Anderson Proton Center w/o %. T3 MRI w/ contrast 1.8 lesion left side 5P, Neg. Bone Scan. Prolaris test 3.5 consistent with intermediate and a PTEN test negative. Father PC age 78 RT & ADT now 93 yrs. Neurogenic bladder due to lumbar disk disease and recurrent bladder neck contracture with urinary retention man. 20 years doing catheterizations. TURP & scaring 2003, Finasteride 5 milligrams daily since 2002.