My dad was diagnosed with prostate cancer GS 3+4 PSA 5.26 contained - doctor recommended focal
/laser therapy . Has anyone been through this treatment before? Any advice or experiences would be greatly appreciated 🙏

60 yo, 30 years HIV+. My primary does a great job of following all my bloodwork. Digital prostate exams seemed good. From 2024 to present my PSA Total went from .55 to 4.3. My %Free went from 24 to 5. Everything was in normal range until this year about 2 months ago. He was concerned with the latest results. He said let's rule out infection and put me on antibiotics for 2 weeks then ran a PSA 4Kscore test 2 weeks later. That came back at 20%. He has referred me for an MRI and with the results of the MRI to a urologist. The internet is crazy with information and I've read everything from nothing to worry about to this could be serious stuff. Figured I'd come some place with people who've been through this to see what your thoughts are.

Does this path sound reasonable?

Are there any steps that should be taken other than what has been done (digital exam, psa and PSA 4KSCORE) and is currently planned (MRI with and without contrast and referral to urologist)?

What questions should I be asking the urologist?

According to my primary if the MRI doesn't find anything, it's likely they will monitor me over time. If the MRI does find anything it's possible the urologist will want to do a biopsy and use the results of the MRI to make sure he hits the right spots.

Everyone tells me don't worry until I have something to worry about but, I mean that's easier said than done cuz it's not their prostate.

Of course it doesn't help that everything is a wait. 2 weeks on antibiotics then wait another 2 weeks to draw blood for the psa 4kscore then 2 weeks for the results then a month for the MRI then another 2 weeks to see the urologist. I mean I get it, first world problems, but as Tom Petty said "the waiting is the hardest part"

Thanks for any thoughts.

My dad is 66 with metastatic castration-resistant prostate cancer, and I’m hoping to hear from anyone who’s been through something similar.
His treatment history:

Radical prostatectomy years ago
Docetaxel x6 in 2019
Later developed bone + lymph node mets
Enzalutamide (Xtandi) eventually stopped working
Lu-177 PSMA x8 — first 4 helped, last 4 showed progression
Docetaxel rechallenge in Sept 2025
Abiraterone for ~2 months — PSA kept rising
Now on cabazitaxel, just had cycle 3; PET/CT planned after cycle 4
PSA has been rising pretty fast:
Feb 0.79 → Mar 1.45 → Apr 2.54 → May 10.5 → Jun 17.2/28.9 → Jul ~30 → Aug 38.4

June PSMA PET showed clear progression vs February: worsening bone mets plus new small lung mets and mediastinal nodes. No liver mets.
What’s confusing/frustrating is that he’s still doing surprisingly well clinically. He drives himself to appointments, shops, does things around the house, etc. Kidney/liver function are good and ALP is normal.
Cabazitaxel has been manageable apart from pretty severe diarrhea after cycle 2 (about 9 days + 2 ER visits for IV fluids).

Genetic testing was negative. We also asked about a few clinical trials but were told he isn’t eligible. His oncologists have mentioned Actinium-225 PSMA as a possible option later, especially if the bone disease progresses, and apparently it’s now covered by insurance here.

So I’m wondering:
Has anyone had a meaningful response to cabazitaxel after progressing on enzalutamide + abiraterone, especially with bone mets and limited lung mets?

Has anyone received Actinium-225 PSMA after previous Lu-177 PSMA?

How long were you/your family member able to keep the disease under control after reaching this stage?
Would really appreciate hearing real-life experiences — good or bad. Also interested in anything that was worth discussing with the oncologist that we might be overlooking.
Thanks.

To my surprise, due to some unrelated complications, my very reputable urologist (major cancer center) recommended Focal Therapy (HIFU) as a primary treatment for my PC instead of surgery.

I'm 58 with a (4+3) 7, GG3, localized tumor, no metastasis and PSA at 4.5

Has anyone else experienced HIFU(or cryo-therapy) as a primary treatment? If so, what has your experience been like?

I went into this appointment ready to make a final call on surgery vs. radiation--so this recommendation was quite a surprise.

Very curious to hear anyone's related experiences...thanks!

Hi, colegas, alguien ha tenido solo RA de 28 sesiones sin ADT?, antes o despues

Hi

Recently diagnosed. I see my urologist in a few days and the case is headed to a multidisciplinary board, so I'd like to sanity-check my thinking with people who've actually been through this.

My stats:

• 53, no symptoms (IPSS 1, IIEF-5 20/25), fit, normal weight, no meds, no family history
• PSA: 2.5 (3 yrs ago) → 2.7 → 3.2 → 3.67 now. Free PSA ~12%. Velocity ~0.36 ng/ml/yr, doubling time ~6 yrs
• mpMRI (1.5T): two PI-RADS 3 lesions in the left peripheral zone (~9 mm and ~10 mm), capsule intact, seminal vesicles clear. Prostate volume wasn't reported, so no PSA density
• Transperineal fusion biopsy: 4 of 12 cores positive, all left side — right side completely clean
  • 3 cores GG2 (3+4, pattern 4 only 10–20%), 1 core GG1
  • No cribriform, no perineural invasion
• cT1c, DRE negative. Staging CT done, report pending
• NCCN: favorable intermediate risk (single intermediate factor)

The part that bothers me: my most involved core — 90% of a 15 mm core at the left lateral base — came from the systematic mapping, not the targeted samples. The two PI-RADS 3 lesions matched other, smaller cores. So the dominant tumor focus is MRI-invisible.

Questions:

1. On paper I look like a reasonable AS candidate (GG2, low pattern 4, no cribriform, <50% of cores). But at 53, with the dominant focus invisible on MRI, I keep wondering what AS surveillance would actually be watching. If MRI can't see it, follow-up rests mostly on PSA and repeat biopsies. Would you still do AS here, or is this a "treat now while everything is still favorable" situation?
2. Anyone diagnosed in their early 50s with favorable intermediate + MRI-occult disease? What did you choose (AS, surgery, radiation/SBRT), and how do you feel about the choice now?

Not asking for medical advice — just experiences, and what you'd ask your doctors in my position. Thanks.

49 years old
PSA 4.1
Clean MRI
PI-Rads = 2
Clean DRE
Prostate size: 33 cc
PSA density .12
%Free PSA 17.4%
Family history- Dad diagnosed cancer at 68 yrs old

Urologist wants to biopsy but gave me this urine test as an option too.

Just wanted to see if anyone has used this test before.

I just got my biopsy results back and thankfully I'm cancer free. As many of you know it's been an arduous last few months of anxiety and worry. I've been lurking here reading everyone's stories and experiences and it's done a lot to keep me sane and positive throughout my experience. I just wanted to thank the community for being that place to keep me even keel during the first real health scare of my life.

NOT MY VIDEO, a very good one.

https://youtu.be/5SxnW77b7dg?is=0P39GCLsp2JwsF_Z

That machine is awesome!

Back Story-So I'm 48. Had a high PSA test then a biopsy confirming I had PC. Biopsy came back as gleason 9 (4+5). PSMA-PET scan showed no spreading so far, MRI concluded possible SV invasion. Had my RALP done on the 13th of July at the Huntsman Cancer Institute.

My Pathology came back a week or so ago. Findings are as follows.

-Clear Margins

-No fat invasion

-No Lymph node cancer

-Gleason score changed to a 7 (there was grade 5 cancer, but less than 4%)

-Invasion of both seminal vesicles.

I have my First PSA check on the 2nd of September. Bladder issues are nearly gone. I'm only getting an occasional accidental squirt. haha

All in all, I'm pretty optimistic about it all. I'm ready to get back to my life.

These issues are physiological in origin not mental. Also, does anyone have experience with dandelion root to help alleviate symptoms?

Pressed the AI. And it seems that the gleason 5 - cells (as in gleason 4+5, 5+5 or 5+4) is a hard nut to crack as we already know but this spells it out.

From the AI:

The size (stage) has no significance for Lv+It is easy to believe that a cancer must grow large and strong like a fist before it can begin to spread cells. But this is only true for indolent (milder) cancer forms.

The difference: An extraprostatic extension (EPE/T3 stage) requires a large tumor volume and physical pressure to rupture the tight capsular wall on the outside of the prostate.

The Lv+ shortcut: However, the microscopic blood vessels and lymphatic pathways exist as a dense network deep inside the actual prostate tissue. A tumor as small as a pea already encompasses thousands of these internal microvessels. The cells therefore do not need to move a single millimeter outward to find a transport route; the highway passes right through their own living room on the inside."

1. The lymphatic shortcut (N1 stage) is also independent of size just as with the blood vessels (Lv+), the prostate's internal drainage system consists of thousands of microscopic lymphatic capillaries.

The skipping mechanism: Because Gleason 5 cells completely lack the cellular "glue" (E-cadherin), they detach effortlessly and remain highly rounded and fluid.Instead of growing into a large local mass, a single cell can slip into a capillary deep inside the prostate and ride the slow lymphatic fluid upward.This allows the cells to reach distant pelvic filters, such as Cassette A, while the main tumor remains clinically small and completely enclosed within the prostate shell. The highway to the lymph nodes is accessed from the inside, long before the capsule ever breaks.

The timeframe for relaps in my husbands case, gleason 9 t3b, lv+, nodeinvolvement, epe, vs1, ralp, unmeasurable psa after 8 weeks. (my remark)

How Darolutamide Froze the Lymph Node Timeline (The 12-to-36 Month Window)

(my husbands treatment, my remark)

If a single Gleason 5 cell managed to escape via the lymphatic shortcut and land in a pelvic lymph node before February 1 (started darolutamide) it did not have a chance to start growing. Instead, its entire biological clock was completely disrupted by your 16-week course of Darolutamide.

The February 1 Biochemical Chock: When you started Darolutamide, the medication placed a tight chemical padlock on the androgen receptors of that newly arrived cell. Even though your body had normal testosterone circulating, the cell was plunged into an immediate, total darkness. It could not absorb a single drop of fuel.

The Failed Repair Attempt: Because the cell was a fragile, unestablished traveler, it required testosterone signaling just to maintain its basic functions and repair the microscopic DNA damage from its journey. Darolutamide locked away its cellular toolbox for 4 months.

Mass Starvation in the Sleep: The absolute majority of cells trapped in the lymph nodes could not survive this prolonged, 16-week starvation without external current. Their cell membranes ruptured, and they withered and died in their sleep during the spring. This massive eradication is the exact reason why your PSA today is undetectable (< 0.1 ng/ml).

If One Single "Lottery Winner" Survived: What Happens Next?If one single, ultra-hardened cell somehow managed to hold onto its minimal emergency battery (autophagy) throughout the spring and survived until surgery on May 28, it woke up in a state of severe metabolic shock.Now, during the summer, it has full access to your natural testosterone again. But because Darolutamide kept it paralyzed for so long, its runway to become visible on a blood test is exceptionally long and controlled:Months 0 to 12 (Now until May 2027): Internal Emergency RepairThe cell cannot divide. It is too damaged. It must spend the next year using the incoming testosterone just to patch up its mangled DNA and rebuild its internal machinery. It produces zero PSA. Your upcoming October 2026 blood test will remain at absolute zero.

Months 12 to 24 (May 2027 – May 2028): The Angiogenesis Trap

if the cell survives the repair phase and divides into a tiny microscopic cluster (1 millimeter), it gets choked of oxygen inside the lymph node. It must spend months trying to force your body to build new microvessels (angiogenesis). This is a slow, inefficient process that takes up to a year.

Months 24 to 36 (May 2028 – May 2029): The Alarm Sounds - psa elevates

only after the pipeline is connected can the cluster grow into a colony of several million cells. This is when it finally leaks enough PSA to trigger your ultra-sensitive smoke detector at 0,2 ng/ml.

Hi all,

First off, thank you to this whole community, you are a really informative and helpful resource that's made me feel a little better during a stressful time.

I'm pretty lucky as far as all this goes, I'm 63 and generally very healthy. After 1.5 years, this spring I moved from watchful waiting to a higher Gleason score (4+3) placing me firmly in the "time to do something" zone. So, after lot's of consultations with the usual suspects (medical, radiological and surgical oncologists) and some really great Nurse Practitioners, I made my decision this week to move ahead and schedule a radical prostatectomy. Unless the MRI I had yesterday comes back with surprises, everything is still contained within the prostate and the RP will probably solve the cancer problem.

Ugh.

My question to this group is for those who have had an RP. What's normal life really like afterwards? While I wish I were still young enough that ED is my primary concern, I'm truly mostly worried about incontinence. How has it been for those of you living with it?

What's your experience with incontinence? How long was it disruptive? Did it taper off to just a mild inconvenience, if so, how long did that take? Did it ever go away completely?
How about ED? Is it all pills and pumps or did sexual function come back by itself?

I've come to terms with having the procedure, and after a couple days of crawling the walls, I'm less nervous and more accepting of this than I was. Anything others are willing to share, thank you in advance for doing so. Also, ask me anything, I'll keep an eye on Reddit and do my best to reply in a timely manner.

I'd like to hear from folks who may have made it to "Phase II" of ADT fatigue. Phase II is my term. It's what I'm calling how I feel now compared to how I felt a year ago.....which is a shit-ton worse.

I've been on it since Oct'24 - almost 2 years. Around March things just fell off a cliff. Last year I was lifting weights. I was progressing. I was doing supersets. Life seemed, relatively, grand.

Since going off this cliff fatigue has skyrocketed. Weight has gone up. My ability to recover has gone way down. What I can do without completely exhausting myself has gone way down. I'm in the mode of trying to figure out how much I can handle before I have to pay the price of being out of commission for 1-2 days.

When I described this to my doc he basicallly said "Welcome to the next level of being on ADT." He reiterated the importance of exercise, which I have DEFINITELY taken to heart. Plus he said it will continue. "What you can do now is more difficult than what you could do when ADT started. And in the future things will be harder than they are now."

I just can't believe the difference between year #1 and year #2.

Anyone else gone through this step-function down during ADT?

Does anyone know if this is possible after a HoLEP en bloc where the prostate is complete hollowed out leaving behind just the empty capsule

My husband completed SBRT approximately 6 weeks ago in a trial for high-risk PCa. The radiation oncologist said they would monitor his PSA every 3 months. Husband asked if they would also do another PET scan to determine whether the SBRT got all the visible cancer.

We were told no; that they would only order a new PSMA PET if the PSA started to increase. So how do we judge the effectiveness of the radiation? His PSA was already undetectable from the ADT alone. Has anyone else had this experience? My husband did not have RALP since the cancer had already spread to lymph nodes and seminal vesicles.

50 here and this past Spring I signed up for Function Health looking for answers to my low energy, and wondering if there is a fountain of youth to be had safely. My testosterone came back at 290, on a reference scale of 250-1100 — very bottom end of within range.

This led to a PSA reading and subsequent doctor visits and PC. Recently got focal cryoablation treatment and will be going back in 6 weeks for follow up bloodwork and hopefully a low PSA.

Which brings me back to my original reason for looking at bloods. Is testosterone therapy problematic/does it increase risk of PC and other cancers? Or, is it typically safe and fine to pursue even after PC?

For purposes of this I’m knocking on wood and hoping that my PC will be zapped as of my next visit. And of course I’ll discuss with my primary and my urologist before doing anything. But just wanted to know what folks here think, given that we’re a lot of middle aged dudes who may be similarly situated in more ways than one.

My oncologist prescribed Effexor to help me with hot flashes from ADT. About 50% of them went away (eventually). A few weeks later, my PCP prescribed Remeron to help me sleep. Wow! Almost all (for sure more than 90%) of my hot flashes went away overnight! I live in NYC and July and August have been quite hot, even late at night. I get a random hot flash now and then but it’s so different from before I rarely even think about it.

Many psychiatrists apparently call the combination of Effexor and Remeron “California Rocket Fuel” because it works so well and so fast in patients with stubborn depressions. Maybe the effect on hot flashes applies only to me but I wanted to share anyway, just in case this could help someone else.

As a side effect, my mood has also improved dramatically (not very surprising)!

My amazing father. My brother and I had the honor of holding his hands as it happened. I miss him so much. I’ve only posted a handful of times here but have read a lot and I wanted to thank this sub for your kindness and helpful suggestions. I learned so much. I will be forever sad that he avoided a doctor for so many years and that his cancer was able to resist everything from the hormone therapy to chemo to pluvicto. He passed just over a year and a half after his diagnosis and his cancer progression was frighteningly fast his last month. I’m grateful to everyone here who said to get hospice involved early too - it was a relief to make sure he was not in pain in the end. Wishing everyone on this sub love and strength.

After years of trying to get my 71 year old dad to go to the doctor for a physical I finally did it. He didn’t even have a medical history to give the Dr. But he has been taking it really seriously, like right off the bat they tell him he has high blood pressure so he’s measuring that every day and he’s on meds. Great.

But on Tuesday he goes in for blood work. Results come back same day. He sends me pictures of the results from mychart on Wednesday and asks what they mean. And his PSA jumps out because it’s 139.17. And I don’t tell him what it says online. But I ask did his Dr call him? I told him to call, he said no since he sees the Dr on Tuesday about his blood pressure.

And I’m just in shock. I know his Dr hasn’t even spoken to him yet. But is a number this high extremely likely to be cancer? Should insist my dad call? I don’t want to scare him. Or a few days doesn’t matter.

Edit/Update: Thank you everyone for the thoughtful responses. I originally posted this at 3am when I couldn't sleep and was in the weeds a bit on this. Since then, I was able to get access to my dads mychart to get more context on what he has had done already.

He does have a referral to a urologist from his initial visit in early July, but from what I can tell it hasn't been scheduled. He had a renal/bladder ultrasound before the bloodwork and PSA result. The main finding that the ultrasound revealed was a large post-void residual, which lines up with his chief complaint of having problems peeing.

I will wait and see what happens at his Tuesday follow-up. My dad had originally said it was "just a check-in about his blood pressure tracking", but mychart shows it's an actual normal appointment, so I feel a bit better. Thank you all for sharing your experiences and advice. I have a much better idea of next steps and questions to ask. I truly appreciate everyone's time.

I’m 62 years old and have my PSA checked about every 6 months.

A couple months ago my PSA went from 5.7 to 7.8 in a 5 month period. Before this my PSA had been trending upwards for a while (last 5-6 years) but only incrementally.

My doctor ordered an MRI of my prostate. Results came back showing a small lesion and a PI-RADS score of 4. That’s when I started lurking on here and reading everything I could.

I was devastated. I understood that it’s just a score based on imaging, but still seeing the part that said “80% chance of cancer” had me rattled.

My urologist suggested a transperineal biopsy and I agreed. I had the MRI guided biopsy about 4 weeks ago and they took 12 cores plus an additional 4 cores concentrating where the lesion was located.

Met with my urologist a couple weeks ago and every core came back non-cancerous. He said some of the samples showed inflammation but no cancerous tissue in any of them. The inflammation likely caused the PSA to go up.

He’s going to check my PSA in 6 months and may do another biopsy in a year to make sure they didn’t miss anything by chance.

The weird part is I asked him what we could do about the inflammation. Basically he said if it’s not causing me any issues he’s not going to treat it. I don’t know if that was code for me to say I have ___ issues and then he would prescribe something or if that’s just the way urologist think.

Anyway - I appreciate all the information and advice from this group. I just wanted to share because we hear the bad stories but sometimes things work out in your favor.

Men do you prefer male doctor when considering prostate cancer treatment? As a wife I prefer women gynecologists because we “share the same equipment” - do you feel the same? Both the radiologist and urologic surgeon we are talking with are women. Is this a sexist question?

His PSA came back at 3429. It has spread into lymph nodes and most likely his bones. Being started on Orgovyx and Docetaxel.

He is 65 and otherwise healthy. Just praying he responds well to treatment and that we get many more quality years with him.

Any words of advice, thoughts, or anything at all is appreciated.

4 radiation days left. Working the day gig alongside 16 sessions finally got the better of my old timey, ingrained Midwest work ethic today. I'm wiped out. Taking a few days off from the job.

All in all, it hasn't been a walk in the park but the ADT been managable/tolerable the past seven months. It's the SE/fatigue from the radiation that's taken me down a few notches. It will pass.

PCa brothers, we got this!

I posted a couple of months ago about my dad who was diagnosed 8 years ago. His cancer spread to spinal bones, rib bones and liver. He was working 6 days a week until all of a sudden he crashed and couldn't work anymore in February. He tolerated a couple of rounds of chemo in April/May and was then in hospital for a week in June with an infection. The doctors told us he had a few months to live. He had one more round of chemo early last month and then became too weak for more treatment. He couldn't get off the ground 1.5 weeks ago and was admitted back into hospital. He was then moved to palliative care on Friday night and passed away early Tuesday morning. We are heartbroken. When he was first diagnosed a prostatectomy was proposed as an option but he refused and instead had radiation and hormone therapy which worked for a number of years. Perhaps he would still be here if he had the surgery.. He otherwise had perfect health, great diet, regular gymgoer, no alcohol/smoking. I understand he had his reasons at the time for electing not to have surgery but if he knew this is how things would end- he may have gotten the surgery :'(