Gleason 10 PSA <4 surgery only???

GPM,

I don't know of anyone who has done what you're asking about. There are a few guys in here who diagnosed at G9, had surgery, and have had no additional treatment. However, the key point is that even if you go for the surgical cure, the odds of it being a cure are not great. You might get lucky. The odds are against you that any monotherapy will cure you.

Grandpa Marv - Can not answer your question directly but I chose surgery which provides the benefit of doing a autopsy on the prostate. That did not turn out as hoped for with a small positive margin and ultimately an increase from G7 -> G9 per 2nd opinion. I studied the probabilities with a 3 month PSA < 0.10 and went with adjuvant radiation (treatment without a number or symptom to base it on) since the benefits were clearly worth it in my opinion with G9 at age 67.

I went through this mind altering thought process three times, first when I decided on surgery, second when the post-op pathology turned up a small margin, and third when the 2nd opinion pathology was not favorable. It was not fun and wrecked my mind for many months. I had hoped for the removal and simple cure but that was not to be had.

You already have the adverse news from the biopsy (to be and not to be confirmed by 2nd opinion soon) so radiation treatment is a given if you want to improve the recurrence odds. This is where the triple play option makes most sense since you can skip the rigors of surgery recovery and go right into one of the radiation schemes and move on. On the other hand, if you are currently having any significant urination issues then the plot thickens a bit as RT does not usually make that better which is the side effects dice that you must roll with any serious treatment.

Hi Mumbo

Thanks for sharing. I've had slow flow for ages so your info there is particularly helpful. Triple play is looking more and more likely. MRI in a couple hours and Hopkins clinic tomorrow. Local rad therapist next week. Decision time soon.

PDA - So ADT and RP would clear up all urinary problems I had catheter out at 10 days, urologist visit at 20 days where I mentioned that I seemed to pee better now although I never really noticed much of a problem previously (must have crept up on me slowly over years without any obvious issues). He said many patients say that after RP. The real side effect is that the off switch gets compromised during surgery many times and the better peeing becomes a liability, certainly at first for many. I have not noticed any significant issues yet after ART although I could tell that it aggravated my bladder a little at the end which settled down after a few weeks after completion.

Mumbo: I'm not saying that RP doesn't fix a slow-flow problem. Most guys who have had their prostates removed pee like draft horses -- like pouring water out of a bucket -- but that advantage is offset by the risk of incontinence and loss of erectile function -- both of which are made worse by the follow-on radiation which is often needed for high-Gleason disease.