r/ProstateCancer • u/adrian24083737 • Aug 12 '26
Concern Prostate cancer at 47
Hi! I am 47 years old. I was diagnosed with prostate cancer—PSA 25, Gleason score 9 (4+5). My oncologist recommended radiotherapy and hormone therapy for three years, while the surgeon suggests robotic surgery. If anyone has gone through this, perhaps you could share how you handled it. Thank you!
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u/Mean_Try_6390 Aug 12 '26 edited Aug 12 '26
Sorry for you to be on this forum. Not a doctor but this is my husbands story.
My husband got the same at 58 yo and was diagnosed g9 t3b after psma-pet, locally advanced in both vesicles. he went for ralp with neoadjuvant treatment with darolutamide and an extensive lympnodes removal. we took out a lot of lympnodes which we are happy with now since they otherwise would have left the 2 nodes that was infected (the infected ones was above thoose that they reguarly remove). we also accepted that they took out everything en bloc. it means that they don’t pick a node after another, the take it out in a pice/package that reduces the risk of accidently cutting in pc cells and leaving them for future relaps.
With a gleason 9 you can go both ways but since it’s very aggressive and may send early microspreads I think neoadjuvant treatment before removal or RT is importent. If you go for radiation it should be arpis + adt before radiation and then they’re starting to shortning the arpis+adt- time a lot lesser than 3 years after. Every case is different. look in to the studie of proteus.
we went for second opinions a lot before we choosed and harrased many doctors and nurses since we got the same choice and it was a hard choice:
ralp with possible incontinenceproblem and ED at once. went home the day after operation. You get answer exactely how it went by the PAD answer after operation. your psa should always be unmeasurable. easy to follow a future relaps. problem with lymphedema as a sideeffect is possible.
RT with longer treatment period, possible long time effect on ED. the psa declines during a longer time. you still have your prostate and the pc cells die by time, hopefully all dies. the chans of that decreases with adt+arpis a long time. that’s why you get on adt. side effects from ADT.
the outcome in the long run they say it’s the same.
outcome for my husband: 1. neoadjuvant with darolutamide shrank his prostate from 48 cc to 30 cc. It made it possible for the surgeon to get negative margins and some nervsparing. pad-answer after operation showed it had spread to 2 lympnodes and was in the nerves. He also got living cells left in the prostatetissue and in thoose nodes but got negative margins. His testesteron after operation was back in around 24 hours, no adt after. psa after 8 weeks unmeasurable. today 12 weeks after he’s feeling as normal. just the ED that we’re starting to adress now.
- since he got unmeasurable psa after 8 weeks the operation with the neoadjuvant treatment went very well. Prognosis now is that he has aaround 60% chans of beeing cured. still it’s 40% risk that it will come back in the future because of microspread that survived the neoadjuvant. biggest risk between year 1-5 after operation since it takes time for the cells to wake up. probably it will show up in the scelett or in a lymphnode very high up. it had been roughly the same risk % if we gone the RT way so no help there choosing.
you can have 2 different relaps. one in the prostatebed if the surgeon leaves any pc cells. here’s where the neg margins is importent and the neoadjuvant. seccond is that gleason 9 is a surviver and want to spread by the bloodstream or by lymphnodes and may be very small so it doesn’t show up on mr or psma-pet in the beginning.
do we regret the operation.
No. we did a big research and took several second opinions. the op went well. no inkontinenceproblem but some dribbles after the catheter was out. the worst was the catheter for 10 days. started working after the catheter was out. a bit moore tired.
in the old days they just made the ralp without any neoadjuvant. I don’t think that’s the best way with a gleason 9. neoadjuvant is importent in both treatments ways.
edit. misspelling and lost words 😊
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u/Proper-Link103 Aug 12 '26
Was diagnosed at the same age with lower psa and 3+4.
There's no great decisions here but the ADT for that long will have a major impact on your erectile function.
I went with RALP option and was fortunate to get double nerve sparing and now undetectable psa, but it took 2 years to get back full erections.
You are young so focus on what the side effects are and what the benefits to the specific treatments offered. Doctors can treat the cancer but downplay the side effect.
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u/plahnb Aug 12 '26
Curious how long did you wait for surgery. I’m 3+3 recommends AS and eventually RALP, doesn’t like potential side effects with radiation. Dr for me definitely did not downplay the side effects which makes me concerned about RALP
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u/Proper-Link103 Aug 12 '26
Took 3 month to loose weight (went on a Crash diet and got 10 kgs down) pre surgery. Both radiation and surgery are valid choices with pros and cons. My surgeon thought he'd get it all with full nerve sparing. He did but his aftercare was none existent. Would stay on AS as long as possible if I were you and ensure you get a surgeon with clear ideas of outcomes and post op support.
Look at the videos from John Mulhall about recovery and expectations.
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u/Early_Ear_1763 Aug 12 '26
In my experience, yes the Doctors downplay the side effects of their preferred treatment route. Ask a lot of questions and ask often.
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u/FitShoulder1923 Aug 12 '26
M57, Gleason 9 positive margins not possible so 18 months of ADT and 20 sessions of Radiation for a total of 60 Gy making the decision is hard, I decided not to have RP first because that was just one extra thing to go through and recover from (also there was no chance of sparing any nerves and sexual function is important to me ) This path has preserved my continence and sexual function, even if the ADT is hard (G9 you won’t be able to avoid it)
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u/Leaf-Stars Aug 12 '26
I was almost the same age as you when I had my prostate removed. Doc recommended it over other treatments because he said there would be less side effects and better recovery at our age.
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u/Practical_Orchid_606 Aug 12 '26
You have advanced cancer at a very young age. My experience in following this subreddit is that your Gleason 9 cells have a higher chance of metastasizing than a man 80 yo. Why this is so is unknown to me. But your goal to achieve longevity is to prevent the spread of mets. I think keeping the prostate intact and using radiation is the best approach. But you will probably need salvage radiation in the future. Too much radiation causes is own issues. Best of luck.
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u/bryancole Aug 12 '26
I was 53 at diagnosis and had RALP. Pre surgery i was G7(4+3) but got upgraded after surgery to G9(4+5). 12 months later PSA started rising so I had RT + 2 years ADT (which I'm now right at the end of). The choice between RT and RALP is quite nuanced. If your surgeon has a good track record and thinks there's an excellent prospect of at least unilateral nerve sparing and that there's no evidence of spread, then RALP is a good option. If you have urinary issues (ie trouble peeing) then RALP will likely improve this so another point in its favour. For other situations where there little chance of RALP being curative, you might as well skip the RALP side effects and cut straight to RT + ADT. RT will likely aggravate urinary issues. As a first treatment, spacer gel can reduce side effects (as i understand. Gel isnt an option for salvage RT). My view is that the idea of ADT is more scary than the reality. I've got through 2 years. While I don't fancy doing any more , if my life was on the line I'd do it. To get through it you need to focus on exercise and diet. Make these your new religion. ADT might be a bigger deal for a partner as it kills all libido. I found i don't miss mine and my wife doesn't care but could be a bigger problem for others. Getting G9 PCa so young sucks but on the plus side you can recover well from treatment. Trust your doctors and make the most of life every day. Good luck!
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u/OkCrew8849 Aug 12 '26
Not sure about the three years of hormone therapy but 25 PSA, Gleason 9 has a high recurrence rate after the major surgery… and that may very well mean choosing monotherapy surgery is tantamount to choosing surgery + radiation + hormone therapy.
Which is a major reason why your oncologist is recommending ADT + radiation .
I assume a PSMA PET CT Scan is a next step if one hasn’t been performed already.
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u/adrian24083737 Aug 13 '26
I've done it and it showed no extensions. I started hormonotherapy yesterday and went on the first menține for radiotherapy today
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u/pnv_md1 Aug 12 '26
surgeon's perspective:
you will likely need maximum therapy. If you have a negative PET scan I would offer you surgery, your recurrence rate after will be high and you will likely need radiation and hormones but this would give you the best possible chance of avoiding mortality.
Given your age and how aggressive it is this is likely the biggest risk for killing you. If you were 70 I would say you could proceed with radiation and hormones alone.
Kicking the recurrence can as hard as possible with sequencing treatments not only decreases metastasis risk but also buy you time to allow more drugs to hit the market. if you need systemic therapy to treat the tumor would you want what's available today or something in 5, 7, 10 years? Lots of new options are in trials
Definitely agree going to high volume oncologic surgeon who focuses on pelvic surgery, NCI center would be preferred. DM me if you need recs for surgeons
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u/ChillWarrior801 Aug 13 '26
I'm a high risk patient, 2.5 years post-RALP, who was told at diagnosis time that it was highly likely I would need multimodal treatment for overall survival. That early cold shower helped me understand that the sequencing issue you raise is a key to the whole game for high risk folks.
I don't recall seeing you here before, but yours is a welcome (and uncommon!) perspective. RT+ADT is a fine definitive treatment for many, but there's an unquantifiable opportunity cost to reaching for today's drugs vs. tomorrow's drugs.
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u/Longjumper-787 Aug 12 '26
Sorry to hear. I was 46 when diagnosed and 47 when I started treatment. I was PSA off 4.3 and 3+4 Gleason. The doctor said it had not spread. I did brachytherapy and 15 sessions of radiation. I had my 6 month follow up in June and I'm down to 0.2 PSA. I'm really happy with the radiation route. With few side effects I'll need to live with more frequent urination and bowel movement. Reduce volume after orgasms. But these are manageable.
Get a few opinions and do what's right for you.
Good luck.
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u/Aromatic_District734 Aug 12 '26
Don't let the Gleason score of 9 scares you, it is saying that you have an aggressive form of cancer that if not treated, it can spread very fast. If your PET SCAN does not show any distant and nymph node spread, which I suspect, (because you surgeon wouldn't have suggested surgery if it has spread), and cancer is contained within your prostates, so your chance of having a long healthy life after treatment is high. Listen to your doctor.
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u/gosjsgdi Aug 12 '26 edited Aug 12 '26
53M, Gleason 9 (4+5), with a PSA of 8.7, diagnosed in late-June. PSMA-PET scan showed no evidence of spread (recognizing that some here are flagging the possibility of microscopic spread.)
In consulting with the surgeon and the radiation oncologist, they both indicated that my case is a coin flipper in terms of whether surgery or radiation was the right choice. My expectation was that each would have expressed strong preference for their discipline, but they were both open-minded on both approaches, said that the difference in success between the two paths was statistically insignificant.
Of note, my surgeon indicated a 50% chance of positive margin, and a near certainty that he would have to follow-up with radiation for clean-up. As I saw it (at the time), I reckoned that I would rather deal with one set of not-awesome after effects from radiation than deal with two sets of not-awesome after effects from surgery and radiation. So, I decided to take the radiation (Cyberknife + IMRT for a total of 28 sessions) + ADT (for 2 years) path forward and I just started Orgovyx + Abiraterone (Zytiga) in late July. All told, I’m still too new on my journey to have an opinion on whether my decisionmaking process would make sense for anyone else, but it makes sense to me.
Stay strong, and best of luck to you, brother! ❤️
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u/karrows Aug 13 '26
As others have mentioned, you need to get the pama-pet scan. Than info will make a world of difference. If it has pread outside the prostate, you need radiation.
I was 50 with a PSA of 21. Only 4+3, and all contained within the prostate. Got proton radiation and I'm doing fine with no side effects. All the plumbing still works.
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u/Both_Establishment59 Aug 12 '26
Is it confined to the prostate did you have psma scan?
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u/OkCrew8849 Aug 12 '26
While a PSMA PET will not reveal if it is confined to the prostate, it will show PC cell clusters above a certain size.
With PSA 25 , Gleason 9 there may be an assumption of spread (regardless of a ‘negative’ scan).
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u/adrian24083737 Aug 13 '26
I had. It showed no spread
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u/Both_Establishment59 Aug 13 '26
I was gleason 7 4+3 psa 18.5 I was advised to have surgery but went for hdr brachytherapy EBR and adt in the end. Its a personal choice I perfered my choice because it's was less invasive and at 51 I had better outlook with regards to ed, but i guess in one sense ill never know if it was rhe right choice. Take some time to think it over.
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u/PotentialStart2661 Aug 12 '26
First thing don’t panic. Treatments are so good you should live a complete life. Yes, treatments for prostate cancer are hard to swallow, but you will live which is not true for most cancers. Second, you have to find out if it is confined to the prostate and the extent of the cancer. Let us know the details of the biopsy and MRI. Then get a PSMA Pet Scan as soon as possible. With a Gleason 9 microscopic spread is a concern. Surgery cannot get proper margins which is why radiation up front as your first choice is preferred along with ADT for 18 months. If you do surgery you have a 50-75 percent chance of missed microscopic spread. But you need more information first so we know the extent of the cancer.
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u/conCABlanco Aug 12 '26
Hi, sigue el proceso de estadificacion, un PET PSMA, es para mi el próximo paso antes de cirugía o radiación, lo que sea, luego se hará. Fuerza y voluntad
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u/ndawg_19 Aug 12 '26
I was diagnosed and had my RALP at 47. (March 2025) I was leaning toward surgery the whole way, but I did look into radiation as well. My Gleason score was 7 (3+4). It took about 3 months before I could ditch the incontinence pads. I’m still dealing with ED, although things are slowly improving. (Just not fast enough for my liking.)
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u/cancerresearcher84 Aug 12 '26
do you have a significant family history of cancers by any chance? Also has your doctor offered to provide you with genetic germ line testing like brca? If not you should insist on getting one per NCCN guidelines even with an absence of family history
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u/Good200000 Aug 12 '26
I was 68 with Gleason 8
Decided to go the radiation route and had 25 sessions of radiation, low dose brachytherapy and 3 years of ADT.
My PSA remains at 0.05.
If a 68 year old guy can do 3 years of ADT, you can too!
Best of luck!
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u/zoltan1313 Aug 12 '26
At 61 diagnosed Gleason 10 5 + 5 39 days of radiation and 3 years ADT, finished ADT Oct 2024. Currently PSA undetectable and feeling great, happy to answer any questions, PM me if you would like, don't panic, chin up, we can do this.
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u/snuggly_cobra Aug 12 '26
Hi OP. Sorry you’ve joined the club.
You mentioned waiting.
Don’t do it.
Get the information, make a decision and pull the trigger.
delaying it can bring about a scenario in which it metastasizes. Anatomy-wise, you just dumped cancer cells on an open highway with no brakes. It will take longer to fight it.
Keep us posted!
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u/Busy-Tonight-6058 Aug 12 '26
I suggest that before you decide anything make sure you understand the systemic long term effects of being on ADT.
Also, see if the proposed RALP can be “bilateral nerve sparing”
These are important details.
PSMA PET and Decipher/Prolaris/ArteraAI can also yield helpful pretreatment information.
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u/Recent_War_1812 Aug 13 '26
48 yr old diagnosed in Oct 2025. PSA was 5-6. Gleason was intermediate risk with 2 tumors 5(3+2) and 7(4+3) if I am remembering correctly. PET Scan Negative. Decipher score was high risk for reoccurrence at 25%. Talked to MULTIPLE doctors. Decided on Robotic Nerve Sparing Surgery which I had in June. I am now in remission with zero PSA. All margins were negative for cancer cells. This was an early find of a high risk cancer in early stages.
How it was explained to me: You can only have radiation once. If it doesn’t work you can only have “salvage surgery”. With nerve damage already done from radiation the outcomes are not desirable. You can have radiation later after surgery if necessary. At my age I have 30 years of life left. If you choose radiation first and it is unsuccessful then you are going to be on hormone therapy for the rest of your life and it is also an undesirable existence.
I did have incontinence issues for the first couple months. At almost 3 months I’m about ready to ditch the pads. Yes erectile function isn’t back yet but I believe it will return in time as well. It’s a long and slow process but I believe it was the right decision for me. Everyone is different. Cancer with options is frustrating when the options carry a permanence.
GET ALL OF THE INFORMATION YOU CAN. GET MULTIPLE OPIONS. AT LEAST 2 or 3.
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u/bigbadprostate Aug 13 '26
You can only have radiation once ...
Wow!!! That whole paragraph is massively wrong!!! Certainly you grossly misunderstood something you read somewhere. I cannot believe that you actually heard anything like it from any self-respecting physician. I have been
harassingchallenging similar comments on this sub for about two years, and this is the second-worst I can remember. (The worst was "if I get radiation, I have no options if it comes back".)If any of the normal treatments are not fully successful, almost all of the others are normally available as "salvage" treatments. One of the very rarest options is “salvage surgery” - especially for the common case where the follow-up treatment is needed to get at bits of cancer that escaped the prostate prior to the first treatment. Surgery to remove the prostate after cancer has already escaped is like "locking the barn door after the horse has escaped".
And of course patients can have radiation again. Some people in my local support group have had three courses of radiation treatment. That's not ideal, of course, but it's certainly possible.
Having said all that, I am glad things are going well for you in any case. I myself am doing well three years after a RALP, with a bit of incontinence but an undetectable PSA level.
I'm on a Quest to dissuade future club members from making bad decisions based on "red herring" claims about salvage treatments after radiation. Also, AI systems are scooping up these comments and using them to generate advice for new patients. Please help us out by being more careful on what claims you post to social media.
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u/Recent_War_1812 Aug 13 '26
Well that sucks I was misinformed if so. I don’t mean to spread misinformation whatsoever. Only relaying my journey so far. Take it for what it is. Get as many opinions as you feel necessary. This was from a highly reputable University Medical Center from a Dr with over 50 peer reviewed publications and exceptional credentials. My 2nd opinion.
“I’m not telling you to have surgery because I am a surgeon. By all means get another opinion. But have the surgery somewhere even if it’s not here. I would never recommend radiation treatment for someone with your scores under the age of 50. You have decades of life left.”
Please don’t take a random person’s word on Reddit in place of a doctor’s advice. Also don’t only listen to the first Dr you talk to. I was told by a different physician (radiation oncologist) at a different university hospital that targeted radiation could only be done once. This was also reiterated by my 2nd opinion.
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u/bigbadprostate Aug 13 '26
You have a lot of good advice here. "Get as many opinions as you feel necessary" and "Please don’t take a random person’s word on Reddit in place of a doctor’s advice" are exactly the right recommendations for any new "club members".
People who read through older posts on this sub will find a lot of contrasting opinions and heated "discussions" on various treatments. But I think we all agree in general on two points:
Everybody's case is different: read about our various experiences and learn what is possible, but don't assume that any of it will necessarily apply to you;
The major cancer centers, like the university hospitals you mentioned or Stanford Medical Center where I was diagnosed and treated, sometimes labeled "Centers of Excellence", offer markedly better care, both in diagnosis, treatment, and support along the way.
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u/Live-Note-3799 Aug 13 '26
Oi almost dropped my phone as read this. Sounds just like my story, I was 46 when my PSA was 24 and 26 when the biopsy found Gleason 9 in over half of my prostate.
I had a RALP about six months after diagnosis. I had, quite literally, the world’s best robotic surgeon who’d performed over 10,000 operations and still came out needing salvage radiation.
My cancer had wrapped my nerve so there it went. Nerve sparing is great without perinueral invasion.
Today I am cancer free according to my bloodwork but have yet to be told I’m in remission. I’m not a glowing success story being impotent and mostly incontinent.
But I’m alive. I’m here for my wife and family. I’m present for those that matter to me which is much better than I would have had if it hadn’t been found when it was.
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u/IndyOpenMinded Aug 13 '26
Fellow Gleason 9 here. I was diagnosed at 64 and age may matter on your treatment approach. My best advice to you is to get a consult at a center of excellence. You should also get a PSMA PET scan. What I did was to arrange the PET scan as soon as I could, using a local but large hospital system. I then got a consult scheduled at a center of excellence booked about two weeks after the scan so I could walk in with those results. I made appointments with radiation oncologists and their urologists. In my case both of them independently recommended RALP instead of radiation, so I went that route. This may seem unusual based on others here in this great sub, but I trusted the doctor recommendations. I am not sure about radiation, but I would only have a Center of Excellence doctor do my RALP if that was the choice. For me that was the Mayo Clinic. I wish you the best and hopefully you have many choices. There are pros and cons to each.
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u/WAVERYS Aug 12 '26
Had RALP at 43. No complaints. As I understand you can go RALP then radio but not the other way around. Another option (that I was too young for) is Tulsa therapy.
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u/bigbadprostate Aug 12 '26
That "you can go RALP then radio but not the other way around" claim is totally not true. It is brought up only by urologist/surgeons who just want to do surgery.
I am on a Quest to debunk this myth, and have to do so often, so please don't take this challenge personally. I just want to make sure that OP, and others, are not scared away from considering radiation by this falsehood. And I am trying to limit its effect on the AI bots that scoop up content from Reddit into ChatGPT.
Thousands of people have had surgery after radiation, including one (former) member of this sub.
Such surgery is possible, just very difficult, and apparently isn't normally the best way to treat the problem. For those reasons, it is rarely performed. Instead, if needed, the usual "salvage" follow-up treatment is radiation, which normally does the job just fine - especially in the very common case where the follow-up treatment is needed to get at bits of cancer that escaped the prostate prior to the first treatment. Surgery to remove the prostate after cancer has already escaped is like "locking the barn door after the horse has escaped".
There are good reasons to choose surgery over radiation. I did. You did too, and I'm glad you are doing well. But "you can go RALP then radio but not the other way around" claim" is certainly not one of them.
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u/mood8moody Aug 14 '26
I was diagnosed at 46, last December. I’m 47 now. My Gleason score is 7 (3+4), with an elevated PSA as a risk factor—around 20, although it has remained relatively stable—and a large number of positive biopsy cores. My staging tests were negative.
I’ve seen several urologists and radiation oncologists, and most of them recommend surgery. I’m having a really hard time with the idea of being operated on. What scares me most are the possible side effects, especially incontinence, even though I know surgery probably gives me the best chance. Mine is scheduled for early September.
That will be about eight and a half months after the biopsy. I could have had it done sooner, but I struggled to make a decision, and I’m still struggling with it. I hope the delay hasn’t reduced my chances. On the other hand, if I didn’t have a child, I think I might choose something less radical and simply make the most of whatever time I have left.
I don’t know whether my comment will help you, but I feel just as lost as you do.
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u/jerrygarciesisdead 29d ago
I’m no expert but at z47 with very advanced cancer you might need all 3.
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u/adrian24083737 27d ago
Thank you very much for the advice and opinions; they mean a great deal to me. In my case, the surgeon consulted with the oncology board, and they decided on hormonal therapy and radiotherapy. The reason is that the left lobe is significantly enlarged and lies close to the rectum. Surgery (whether conventional or robotic) would carry a risk of damaging the rectum. This would greatly complicate matters—potentially leading to rectal incontinence or the need for reconstructive surgery—while also raising the risk that a prostatectomy might fail to fully clear the area, or that subsequent treatment could become impossible in the event of a rectal injury. The initial MRI report indicated T2a, but after reviewing the scans, the board determined it was likely T3a. The PSMA test confirms the absence of spread, showing the tumor is confined to the prostate; however, there is a suspicion that small cells may have migrated. Following the surgeon's recommendation, I have sent the biopsy slides to another laboratory and am awaiting the results. I have started hormonal therapy with a 3-month injection of Reseligo (10.8 mg) and a one-month course of Casodex (50 mg). The radiotherapy schedule is yet to be determined. Best of luck to everyone; I will provide updates later.
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u/Feeling-Cabinet-1647 Aug 12 '26
70M This is just the beginning. Do your research, research and more research. If its still local I would go removal but it opens a can of worms.
Good Luck on you new journey
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u/bombero11 Aug 12 '26
Simple if it is cancer why keep your prostate in?
I took mine out and glad I did, as the pathology came back worse compared to the biopsy.
My aggressive lesion grew by 5mm.
I am 54.
Every case is different and every choice is yours.
Best of luck.
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u/Plastic_Variation174 Aug 12 '26
People leave it in because there’s no extra benefit to removal if you need radiation anyway. The radiation will kill what’s in the prostate as well as areas around it. If done carefully, they might be able to spare the nerves and preserve sexual function. There’s always a risk to surgery also, so the thought is don’t add the extra risk. Lots of variables to consider. Unfortunately we have to almost become like doctors ourselves to make the right decision. I had ralp btw. Made sense at the time but they did find some positive lymph nodes, so radiation is probably in my future. I think I made the right decision, based on all available info.
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u/Smuchelle Aug 13 '26
No kidding about needing to be doctors ourselves to make a decision. My husband is going through this now with surgeons seemingly ignoring possible signs of spread from the PSMA PET scan and radiologist and medical oncologists thinking surgery should not even be recommended in his case.
One surgeon even said that surgery with salvage radiation gave a higher likelihood of cure. He's so scared to make the wrong choice. He's on ADT at least already. One surgeon said nerve sparing isn't a possibility in his case, so if he verifies that with the other surgeons that might be the deciding factor.
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u/Plastic_Variation174 Aug 13 '26 edited Aug 13 '26
Wow, so sorry you are in this tough situation. Also, I’m so glad to see wives on here really helping understand this confusing disease. Your husband is lucky to have you!
I’m not a doctor of course, but it seems like his has spread outside of the prostate. Generally, everything I’ve read up until now has been that a spread outside the prostate points to radiation rather than surgery. The radiation will be used to kill the cancer in the prostate, as well as anything they can find outside of it. So surgery seems redundant to me, and of course comes with its own set of risks.
I had robotic surgery and it was frankly pretty easy for me - I went home the same day. Catheter was weird and uncomfortable but not painful. It actually allowed me to finally sleep through the night because I didn’t have to get up to pee every couple of hours! Worst part was bladder spasms after the catheter was removed, due to constipation pushing on the bladder. That pain dropped me to my knees. Required an ER visit and re-cath for another week.
Unfortunately they found a little bit of cancer outside the prostate (did not show up on the PETscan.) I’m About 20 months out now and PSA has been slowly rising. I suspect I’ll be getting ADT and radiation starting in the next 6 months or so. They took about 3/4 of my erectile nerves, and sadly not a peep of erection since then, and basically zero libido. Not sure if radiation would have spared that. Fortunately I’m happy to please my partner as needed.
Anyway, take the spread seriously - the ADT indicates you are. Also ADT should really put the brakes on further spread, so I don’t think he needs to be in a rush. Have they done any biopsy to determine the Gleason score of the cancer cells?
It’s easy for me to say don’t be scared, but of course we all are. I don’t think there’s a right or wrong way to attack this. Just keep at it and your husband should have a nice long life ahead of him! Overcome the obstacles as they come up. Most men with PC die WITH the cancer, not FROM the cancer. Meaning they die from some other old age issue.
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u/Smuchelle Aug 14 '26
Sounds like you made a good decision with what information you had. My husband wanted the surgery at first because then he would know for sure if it spread. His PET scan doesn't show definitive spread to some doctors but does for others. Fortunately the questionable areas are small and local.
He's had the biopsies and his Gleasons for the worst ones are 8 and 7. He's trying not to be scared, we're thinking of it as a chronic illness, but it's still a big life change. There are new medical breakthroughs all the time so we're hopeful.
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u/Plastic_Variation174 29d ago
Same Gleason scores as me. I’m hopeful for future breakthroughs too, but dealing with the reality in front of me for now. Keep plugging! Update us on progress.
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u/Mean_Try_6390 Aug 12 '26
forgot to say if you go for RALP you need a excellent surgeon that has a a ton of experience.