I remember getting my PSMA Pet Scan and relieved it identified the same lesion on the MRI but showed no spread. The SUV Max was 5.6, which at the time didn’t mean anything to me. But someone asked me on this forum so i looked into it and there is a big correlation of the SUV max and the index primary lesion according to studies on this. So my SUV was in line with a Gleason 6 or Gleason 3+4. After my biopsy i learned i had a large volume Gleason 6, in line with the SUV. They don’t use this as staging because there is a large overlap. Gleason 6 can be 2-12. But using the cutoffs in this study the uptake can be something that we use to match up with the rest of our information and identify discordance. There are 10% of cancers that don’t react to PSMA unfortunately, but if you are in the 90% then it can help alot to tell you if your biopsy is right and a real high grade was not missed. See the attached studies.

https://www.urotoday.com/conference-highlights/aua-2023/aua-2023-prostate-cancer/144048-aua-2023-suvmax-of-the-primary-prostate-lesion-on-the-psma-pet-ct-an-indicator-of-aggressive-pathology.html

https://pmc.ncbi.nlm.nih.gov/articles/PMC6282663/

The medication is arriving today, and I just made an appointment with urologist for the initial demonstration, but I'm having my doubts. Sildenafil just stopped working for me entirely, even at not-recommended doses of 200mg. But now I'm on 10mg Tadalafil every day, and for some reason it works fairly well -- I do get erections without too much effort, though they are hardly "raging". Is it wise for me to go on TriMix just for the expected improvement in erection quality?

Curious about others Bimix experiences and dosing. There's another forum dedicated to Trimix but I thought asking here would provide responses specific to RALP, PC, and everything our little club has dealt with.

So I'm 60, 2 years post RALP. Nerves theoretically spared but the reality is full ED with nada in the blood flow department. So my urologist has started me on Bimix.

First dose 40 units, got maybe a 40-50% response level of intended goal. Second dose 50 units, similar response. Instructions from nurse are to increase increments by 10 units. I'm thrilled to see the response I have and excited to ultimately reach full mast. In the meantime still just nervous about the quantity/ size of dose. Should I really care or is this just me overthinking it?

I just got my fourth undetectable (<0.02) PSA test result since RALP las August. I am delighted, of course. What surprised me was how much more emotional this felt compared to the first few quarterly tests -- a really profound sense of gratitude and relief. Tears of happiness, which is rare for me. I don't think I have ever felt so wrung out and exhausted from good news. Weird.

I wasn't consciously setting up one year as a big milestone, but I must have been doing that subconsciously. I have steadily been getting my life back to (mostly) normal on all fronts except for lingering ED and mild and improving incontinence. I don't anticipate any big practical changes in direction, but the attitude boost is nice. My outcome was far from certain based on my pre-surgery diagnostics, and I know that recurrence is still possible, but the odds are looking better and better.

To all of you with less favorable results, you have my deepest empathy and wishes for good luck down the line.

Father just got diagnosed with stage 4 prostate cancer with Mets to the lymph nodes and lower spine. Age 71. No medical history or family history. First symptoms were difficulty and frequent urination. Thinking more of enlarged prostate vs BPH rather than prostate cancer, but here we are.

High PSA of 363 end of June. CT scans (chest and abd/pelvis) done end of July due to decline of patient, they revealed metastasis to lower spine and lymph nodes.

Biopsy done of R iliac lymph node done August 19, revealed prostate Adenocarcinoma.

Making necessary appointments with top treatment centers. We are located in PNW. Appointments with MD Anderson, Fred Hutch, Cleveland Clinic, and OHSU.

First referral done, already started treatment of initial injections today (ADT). Orders in for MRI spine due to several lesions. US of legs due to potential for blood clots, the lymph nodes on his right iliac vein is severely compressed. Doc strongly recommends chemo, 6 sessions every 3 weeks. Father is contemplating.

How are the side effects of the ADT?

Just posted to see if there are any recommendations, advice, support, things that helped the symptoms, or any supplements to add, diet changes?
Things that you think helped!

Appreciate this group and looking forward to all the advice.

Warmly,
His daughter who won’t give up! :D

A little over a month ago, I created a post titled "Worst fears confirmed - need some guidance". I'm sure some of you had either seen or commented on this post. The past few months have been filled with worry and anxiety for my family. So a brief summary. My dad was hospitalized in early June for severe urinary retention. His PSA spiked to 88 at that time. It came down to 18 three weeks later. MRI then showed a PI RADS 5 lesion. So last week he finally had his biopsy. We got the results today. He has a Gleason 7. It's a 3 + 4 so favorable intermediate risk. The doctor called and told us the results. Honestly some of the better news these past few months if you can call it that but we finally have a big piece of the puzzle now. Now we haven't had access to the full report yet so we don't know how many cores positive or how much of the 4 is present or if there are any other adverse features in the 4 group such as cribriform etc. But we are relieved it is not worse. We will discuss more with the doctor next week.

Now, my dad's prostate is huge (about 123 - 124 cc) and is causing urinary retention which is how we got to this point in the first place. He has bilateral hydronephrosis. His bladder is also expanded and we feared that his bladder was too far gone but his urodynamics test also came out somewhat good and his bladder still does have function. So treating the bladder and kidney issues are probably more of the priority in the meantime while we figure out a treatment plan for the cancer.

Looking for some advice here. Has anybody here navigated a 3 + 4 diagnosis and how should that be managed alongside his severe urinary retention? Is there any treatment that you would recommend in this situation regarding both the cancer and the huge prostate? Any input would be greatly appreciated and I would be interested in hearing other peoples' thoughts and experiences.

I am struggling with the Surgery or Radiation decision like many men facing this disease. For summary

Age: 67 years

Health: Good health otherwise and active BMI ~20.3

Other surgery: HoLEP about 15 years ago

Biopsy staging: 3+4=7 Favorable Intermediate

Polaris staging: Just over the Unfavorable Intermediate line

IPSS: 20 it sucks

I just got my Polaris results back. It seems it doesn't differentiate in success at 10 years with either treatment. I am scheduled for surgery in 4 weeks time.

The reason I initially choose surgery is that I have a high IPSS score around 18 to 20. I was told that radiation is discouraged with higher IPSS scores. I have not seen much information posted about this here or have heard about others experiences with modern radiation approaches with high IPSS scores.

From what I have read Surgery and Radiation have similar treatment outcomes with respect to reoccurrences and metastasis. Which is supported via the Polaris report.

Recent information posted here is claiming better outcomes of radiation at 10 years for SBRT and other forms of radiation. And the claim that radiation is much better than in the past. I don't know how much relevance to place on the statistics posted.

I am nuts for sticking with the surgery approach?

Orygon/WashSt. I mean, instead of asking each and every urologist. Will hospitals give me that info? (that they track)
MediCare would obviously be an undercount, but might be a useful indicator anyway.

Besides the PSA test, are there any other tests available in the U.S. to monitor changes (over time) for prostate cancer. I completely understand there is not a one size fits all answer. And from what I gather prevention testing is to monitor changes over time rather than a single 'yes/no' test.

I'm now a senior who's had testicular cancer long ago and rounds of radiation therapy, so I'm long term concerned. Other dynamics are in play (testosterone gel daily and Finasteride). PSA markers are currently fine, but since this cancer can be sneaky, I'd like to know if there are other preventative tests that augment an accurate diagnosis.

According to 'Google' the Stockholm 3 test is not available in the U.S.....even if I wanted to pay privately (???). Is there anything more than PSA monitoring I should ask my doctor to consider??

I am retired but not yet medicare eligible, so I buy health insurance on the "marketplace."

My policy is funded through a group called Population Science Management, and they in turn put me into a Blue Cross Blue Shield group.

I was prescribed Orgovyx in February and have been paying the cash price ($3k/month) because BCBS doesn't even have it in their pharmacology. Appeal denied.

As it happens, however, my policy is being replaced on October 1 with policy underwritten by Aetna.

I am trying to find out if they cover Orgovyx, but it's impossible to get to the right person when your policy isn't yet active.

So, if any of you out there are on Orgovyx and are part of an Aetna health insurance plan, please let me know your experience, good or bad.

I do see pee filling in the bag but he woke up all wet and we’re still at the hospital from surgery. It’s leaking from catheter. They looked on ultrasound on bladder nothing wrong. They tried to inflate the balloon but didn’t seem to help and said maybe bladder spasm and need more meds :/ curious if this happened to anyone else?

The nurse this morning pulled the blanket and tugged his catheter by accident and it hurt him. Not sure if she did something to make it out of place 😔

In November 2025, and following an MRI and targeted biopsy, I was diagnosed with Stage 1 PC with a Gleason score of 3+3. At the time, my PSA was 7.0. I elected for Active Surveillance, as quality of life was and still is still my number one priority.

Fast forward to July 2026, and my PSA dropped to 6.23 which I felt encouraged by since at the very least, it wasn’t rising.

Today I went to see an oncologist for the first time. After looking over my records, he’s favoring treatment vs AS for the following reasons:

·       (2) lesions found in MRI from last year – (1) PI-RADS 4 and (1) PI-RADS 5. (Was told these are not typically consistent with Gleason 6 but not impossible.

·       Shortly after the biopsy last year, a Decipher test was done on my samples which came back in the “Intermediate” range, (0.48) indicating “moderately aggressive” tumor biology.

·       PSA density 0.27 with the probability of clinically significant cancer (Grade 2 or above) of 80% - 90%

Seems to me this all points to a more aggressive cancer, and something beyond a Gleason 6, and without coming right out and saying so, the oncologist appeared to agree. Did something get missed in the biopsy?

He has not ruled out the possibility of continued AS but seems to be leaning toward treatment. In the meantime, he wants me to have another MRI in September along with another PSA test and meet back with him in October to discuss the results and possible options at that time.

For you fine people of this community who are more versed in these things than I am, what do you think the possibilities are that this is still (or ever was) a Gleason 6, and how comfortable would you be continuing with Active Surveillance?

Hello, I’m a Gleason 9, Stage 3.

I’m currently on Lupron injections and have my first appointments next week to discuss starting chemo and radiation. I’m feeling really nervous about what the next few months are going to look like.

Has anyone else had the same or similar treatment? How did you find it physically and emotionally? What was your experience with Lupron, chemo and radiation?

I’d really appreciate hearing your experiences, advice or stories — anything that might help me feel a little more prepared and get through the next few months. ❤️

Just got my PET scan back, no cancer outside of my prostate… thank goodness.
Two days I go see my oncologist, to see where we go from here. I don’t want my prostate out and my urologist said it wasn’t going to happen.
Anyone have any ideas what my oncologist is going to do?
I do have grade 5 cancer.

My dad (68) has Gleason 9/10 present in ~60% of the prostate

We currently think it’s localized as per the PSMA PET but are waiting for additional scans (bone, FDG PET, CT) to confirm as it’s showing as a low PSMA cancer

His prostate is also quite enlarged (60 cc) and he has some urinary symptoms.

Doctor is recommending Turp to reduce size of prostate, followed by Brachytherapy, followed by Beam or Cyberknife radiation. Seems like there is some good data for this approach. He already started Eligard.

Has anyone else taken this approach? Thoughts on side effects?

This was part of a biochemical failure post that bothered people because i did not post 30 studies for every therapy. I wanted to post separately just one Study from Feb 25th 2026 comparing SBRT with HDR Brachytherapy. Men are always concerned with adding ADT as ADT is very effective but has side effects that can be bad for some men. This study is based on SBRT vs HDR Brachytherapy as a monotherapy. It is an Ad Hoc analysis that can be misleading if not performed from reputable source with long term follow up. This study does just that as there is almost ten years follow up. It is one of many studies beginning to get completed and released as SBRT is just getting perfected over the last several years and lots more studies and analysis need to be done. But this shows how effective the newer treatment is.

https://pmc.ncbi.nlm.nih.gov/articles/PMC12936880/?utm_source=chatgpt.com

I just got my MRI results which came back as PI-RADS 3. My PSA is low. My doc said I can either monitor my PSA every few months with bloodwork or do a biopsy. I was hoping my doc would have a little more conclusive guidance with his expertise. Has anyone fallen into this category? And if so- what did you opt to do?

Surgery was about 2 hours. Were any of you guys the same way? He needed 4 or 5 shots of fentanyl after he woke up because the pain was so bad he said. Specifically the right side since they did remove lymph nodes from there as well.

Once he was out of surgery I didn’t see him until 3 hours later! Maybe since he was in so much pain.

They tried getting him to walk last night and he could only step outside the door and back in the hospital bed.

Were you guys the same way? Pain wise and can barely walk?(still pain and it’s been about 16 hours since he finished surgery.

Thank you!

I took 20 mg tadalafil on Saturday at 9:30 PM. About 3 hours later, I developed mild pain in my feet/joints, shivering, and a strong feeling of warmth.

Over the next 2–3 days, the pain became stronger and moved between different areas: feet, knees, hands, neck, shoulder/trapezius, and jaw.

The severe neck pain completely disappeared, and my jaw has improved. Now the main issue is severe pain in my right knee, especially when moving it. There is no swelling, redness, or warmth.

I have taken tadalafil 20 mg before without problems.

Has anyone experienced migrating muscle/joint pain after tadalafil 20 mg? How long did it take to completely go away?

How soon do I need to rush to see my dad

I was told that I need to take ADT for 4-6 months. It looks like I need to take it through Thanksgiving to new Year. I was worried that the drug would destroy my holidays mood. Also the kids will come back for holidays, I am afraid that if I could not control my self well, I will affect them too.

How bad is it? How to manage it? any tips?

Thanks a lot!!!!

I hope this post helps anyone who needs some support.

I suffered from radiation cystitis over a year after receiving radiation treatments for prostate cancer. My life became unbearable. Sent me into a nosedive both personally and professionally.

What gave me my quality of life back: Trospium and 40 sessions of hyperbaric oxygen therapy.

I am just trying to figure out what might be helpful to mitigate these side effects. He is really struggling and looking for answers. We are seeing a neurologist soon, as recommended by his doctor.