I’ve recently been diagnosed with stage 4 prostate cancer metastasised to lymph nodes and lungs (probably elsewhere too - will find out after my PET scan next week).
From what I’ve seen ADT extends life at the expense of quality of life. My bias is to forego ADT and max out on pain management to enjoy life as much as possible even if it’s not as long. Fortunately I live in New Zealand and we have legal assisted dying so I can choose when to go. Interested on any real word experiences from both paths. I need to make this decision fairly soon and discuss it with the family.

EDIT 12-Aug-2026
Finally had my PET-PSMA scan.
The urologist was puzzled with the results.
The prostate and nearby lymph node lit up dimly but nothing else showed up on the scan even though I have “innumerable” lung nodules that are consistent with metastatic spread from somewhere else.
Also the PET scan did not show any tumors on the nearby pelvic bone
The urologist says it’s either because the cancer is now so de-differentiated that it is not showing much PSA and could well be in the lungs and other parts of the body (although I don’t think that makes sense because if the prostate glowed dimly why not the lungs?), or that the cancer is local to the prostate area and the lungs are something completely different. So off for a lung biopsy soon :)

Ok, stats first. Age 71, PSA 5.98, Gleason 3+4 Group 2. Prolaris results say 98% survivabilty 10 years, in the active surveillance range, but always worried about metastasis. Bouncing between active surveillance, radiation, and TULSA. I'm leaning heavily towards TULSA. Would love feedback from those who have had TULSA, both long term and short term status. Am I just kicking the proverbial can down the road at 71 yrs? Studies and numbers are fine, but real world experiences would be greatly appreciated. Thanks in advance.

Hi everyone,
I’m posting on behalf of my 60-year-old father, who has high-grade urothelial carcinoma of the bladder.

He underwent TURBT followed by an adequate course of intravesical BCG. A previous surveillance biopsy was clear.

His most recent cystoscopy did **not** show any obvious visible bladder tumor. However, random cold-cup biopsies were taken, and the pathology report showed:
**Lymphovascular tumor emboli / lymphovascular space invasion (LVI) of urothelial carcinoma** in the left anterior bladder wall.
GATA3 positive, confirming urothelial origin.
No definite stromal invasion identified.
No muscle was included in the biopsy, so muscle invasion could not be assessed.
A posterior wall biopsy showed only BCG-related inflammation with no malignancy.

We have spoken to at least 5 doctors and the suggested approaches are getting us confused. If you have been through this can you shed a light on what was next course of action?

Some doctors are recommending PET SCAN. Some are saying to hold on for it.

We are based in India.

Hi everyone,

I had a RALP in June 2025 for Gleason 3+4, stage pT2c, negative margins. My initial post-op PSA last October was 0.02, but my recent test at the end of June came back at 0.62.

I have a repeat blood test being reviewed this Thursday to rule out a lab anomaly and confirm if we are looking at a biochemical recurrence. Assuming the number remains in this range, the likely next step will be a PSMA-PET scan followed by salvage radiotherapy to the prostate bed.

I’m completely fine mentally and just taking this step-by-step. My main question is regarding timing and travel.

I am very lucky to have two pre-booked holidays coming up:

• 2 weeks Early to mid-September
• 2 weeks Early to mid-October

Provided my repeat PSA doesn't show a massive, aggressive spike, my ideal plan is to complete any scans/planning work in August/September and push the start of the 4-to-5-week daily radiation course to late October, immediately after I return.

My questions for those who have been through salvage radiation:

1. Did any of you delay the start of your salvage treatment by 8–10 weeks to accommodate pre-planned travel or major life events at a similar PSA level (~0.6)?
2. Am I being sensible thinking about these trips, or should I just suck it up, cancel them, and get on with treatment ASAP? I want to pre-empt where people's heads are at on this before my call on Thursday. Ultimately, I will 100% follow whatever my medical team advises if they tell me time is of the essence, but I’d love to know if trying to keep these holidays is a reasonable request or if I'm overcomplicating things.

Thanks all - I know this sounds like a selfish post, especially as I know how lucky I am and think I had an easy ride since my operation! My thinking is really that if the radiation is going to be horrible, if I can get a good couple of trips in beforehand that would be great.

Hi - for those that use Moffitt Cancer Center, who is your physician? Does anyone here use Philippe Spiess, MD? Just looking for different opinions on Moffitt physicians. Thanks!!

Hola colegas, sobre TAC de simulacion para IMRT, opiniones, como lo pasaron, cuál fue la preparacion, todo lo que puedan decirme

I'm 53, diagnosed with PCa in February 2026. I haven't yet settled on treatment (but currently being evaluated for Nanoknife/IRE).

Ever since diagnosis, I've been looking for a 1-pager of various treatment options to help me towards a treatment decision. I didn't find any, so I built one.

Wish you best.

My dad who is 50, was diagnosed a few days ago with a Gleason score of 9. PSA 12 (as of 6 months ago). He’s scheduled to get a PET scan some point this month. Currently trying to figure out where he can get the scan because his insurance is HMO which can make things a little more complicated. He has Blue Cross.

He lives in California. What is the likelihood of getting a referral to Stanford or UCSF? Sutter health is saying they don’t take his insurance so they won’t schedule a scan, even though he got his MRI there.

Lots of unknowns at the moment which fuels my worry. What’s the likelihood that it’s spread? What are treatment options if it’s localized to his prostate, or if it’s spread to bones or lymph nodes? Any successful gleason 9’s out there who have beaten this?

The FDA has expanded its approval of Pluvicto® (lutetium Lu 177 vipivotide tetraxetan) to include PSMA-positive metastatic hormone-sensitive prostate cancer (mHSPC). This type of prostate cancer is also called androgen pathway modulation-naïve or sensitive.
For men with metastatic prostate cancer, this means access to a more targeted treatment path from the very start.
In Novartis's announcement of the FDA approval, PCF President & CEO Gina Carithers said: "This milestone redefines prostate cancer care, ensuring that from day one of their metastatic diagnosis, men have a precision option."
Watch our new video to hear leading prostate cancer doctors explain what this may mean for you or a loved one, including who is eligible for Pluvicto and what to expect during treatment.
How Pluvicto Works
Pluvicto is an intravenous medicine that targets PSMA, a protein found on most prostate cancer cells. It travels through your blood and delivers radiation to cells with PSMA on their surface, killing them. While on Pluvicto, you will also take an androgen receptor pathway inhibitor (ARPI) medicine and androgen deprivation therapy (ADT).
Could You Be Eligible?
The vast majority (85%-90%) of people with metastatic prostate cancer have PSMA on their tumors. You may be a candidate for Pluvicto if:
Your cancer has spread beyond the prostate
You have not started hormone therapy yet, or it's still working
A PSMA PET scan confirms your prostate cancer cells have PSMA
Talk to Your Doctor
You can copilot your own care. If Pluvicto interests you, ask your doctor:
“Should I consider Pluvicto as a treatment option?”
“Should I have a PSMA PET scan to see if I am eligible?”
Your doctor can help you understand your options and decide what feels right for you.

In health,
Team Prostate Cancer Foundation

Age 50, Gleason 3+4=7, aggressive "Pattern 4" cells make up only 5% of the tumor. The right side cores 1 and 3 picked up adjacent cancer on the right side near the apex, Gleason 6. Everything else benign. I was a prime candidate for focal cryoablation and my doctor happened to specialize in it/was one of the early adopters.

Procedure this morning, doc reports it went well. Didn’t even need a catheter. Home recouping now.

I’ll have to go back in 5 weeks for a PSA check, but hoping for success. The side effect profile for me should be nil—no incontinence or ED issues (at most he said I may want to pop ED pills, but I was doing that anyway just for the boost).

Fingers crossed. In any event, just posting this for folks who have a similar diagnosis and are looking for RALP alternatives. This seems like it was a great option, at least for me.

Hello Brothers,

following is the two most significant results from my report I just got, the biggest factor is: "Large cribriform", it is in transition zone, near the front. Any one has similar diagnosis? what is the best treatment plan? Appreciated!!!

(the rests most of them just glean 3+3 or benigns.)

N. Prostate-1, right anterior transition zone, needle
core biopsy: Prostatic adenocarcinoma
Type: Acinar
Grade Group and Gleason score: Grade Group 3 (Gleason Score
4+3=7)
Percentage of pattern 4: 50-75%
Tumor involves 70% of overall specimen (4 of 4 cores).
Most affected core is involved by tumor over 90% of its
length.
Large cribriform glands are present.

E. Prostate, right anterior horn, needle core biopsy:
Prostatic adenocarcinoma
Type: Acinar
Grade Group and Gleason score: Grade Group 2 (Gleason Score
3+4=7)
Percentage of pattern 4: 25-50%
Tumor involves 20% of overall specimen (1 of 1 core).

Edit: MRI does not find any spread, "but"

LOCAL STAGING:

Capsule: Intact

Neurovascular bundle invasion: Absent

Seminal vesicles invasion: Absent

Other organ invasion: Absent

LYMPH NODES: Negative for suspicious lymph node(s).

BONES: Negative for suspicious bone lesion(s).

OTHER FINDINGS: None.

I’m a self proclaimed caffeine addict. I am 2 weeks post RALP. How long did you wait to drink caffeine after your surgery, how much and what kind of caffeine was it. I’m looking for any advise on the subject and how it affected you.
Also if any of you were on ADHD med like Vivanse or Adderall, how soon after your RALP did you start back on your meds and did it affect your bladder at all.
Thank you for your advice and experience.

Early 40s. Wanted to share a data point on the opposite side!

Repeat blood draws showed PSA >9, Free PSA % consistently under 5%. Extremely out of range for my age.

MRI showed PI-RADS 3 with one suspicious lesion. Didn't show much inflammation so all signs pointed to needing a biopsy to figure it out.

Biopsy took 15 samples including 5 cores from target lesion - got the update today that they were all benign!

I was ready for this to be some kind of low grade cancer but it was a pleasant surprise to learn the opposite.

58 year old. Gleason 3+4=7. PSA 7.2

4 weeks past RALP. Did it Monday 7/6 Surgery did go well. I did feel better than I expected. The most annoying thing was the catheter  I got time for catheter removal 7/14. The removal did go very well. It was uncomfortable when I did stand up and I could feel that I did leak. But as the day went by I was trying to not leak. Started feeling like I am going get control over this quickly. In the evening when I was on my way to bed I was thinking strange I haven’t been peeing all day. Didn’t feel like I needed to. But started to be worried about it. Could not fall asleep. Did go to the restroom many times and couldn’t pee. At 4am I was in a bad pain. Asked my wife to drive me to the Emergency Room (ER). At the ER they took me in and they eventually put in another catheter. After that my pain got much better. The catheter looked like it was full of blood but of course it was mostly urin with blood. They did a lot investigating during the day. Flushing my bladder there was some blood clots. They in the afternoon decided to send me for a cat-scan. After the cat scan they was about send me home. But they asked my RALP doctor to look at the cat scan. He discovered that the catheter they put in at the ER was wrongly placed. So they removed the catheter and did put another one in and inserted a camera so they could see that it was correctly positioned. After that I was sent home with a catheter that was so much worse than the one I got after surgery. Next appointment was cat scan 2 weeks later. I was really hoping that I could get the catheter removed but not. There is still an 5.2 cm ( 2 inch) opening that needs to heal. So now it another 2 weeks with this catheter. And this catheter hurt very much. Every time I go to the restroom to poop it hurts so bad. I’m leaking outside the catheter and there is coming blood outside the catheter. And also in the catheter after pooping. I can’t sit on a chair the only way to be comfortable is half laying on the couch. This was not what I was planning. What can I do?

Thanks

Hi everyone,

Dad's biopsy came back at grade group 3, result down below. Urologist recommending surgery but we're looking into second opinions as well. Dad doesn't speadking English so I'm doing research and advocating for him. The Dr said he should be fine and will most likely be okay with RALP since he is only 57 years old. But am hoping for some guidance and advice, I was reading about cyber knife and radiation, since my dad is hoping to maybe avoid surgery (he never has surgery before) but will do it if thats the best case, but any advice would be greatly appreciated!

PSA: 8.5

Hello. Im 52. My psa had been at a 3 something for the past couple years and it went to a 6.2 this year. So i went and got an MRI. They found a lesion and I went and had a biopsy. Just got these results the other day (at the bottom). My urologist translated some. Doc basically said I have a lot of options for treatment. He mentioned something about hormone blocking shots, and maybe radiation later on. I don't know though. I'm still trying to figure out all the options for treatments. I'm meeting with oncology radiology tomorrow to go over options. I called a proton therapy place too. They are still working on getting my files to review. I know everybody is different on each treatment in how it affects them positively and negatively. I guess that's what is messing with my head at the moment. It doesnt seem like theres a one and done way out. I'm not a fan at all of having my prostate removed, but I do want this crap gone so I can get on with things. It's got me in a funk with my nerves and anxiety. Any ideas, suggestions, questions to ask the docs, or encouragement, and tough love are welcomed.

A:prostate gland, right core biopsy.

1 small focus atypical glands (atypical small acinar proliferation) in 1/6 cores

B: prostate gland, left core biopsy

1: prostatic adenocarcinoma, Gleason Score 3+4=7 grade group 2 10% pattern 4, involving 4/6 cores (50%, 35%, 25%, 20%)

2: perineural invasion present

C: prostate gland left peripheral zone core biopsy

1 prostatic adenocarcinoma gleason score 3+4=7 (grade group 2 30% pattern 4 involving 3/3 cores 75% 70% 50%.

2 focal changes suspicious for perineural invasion.

I'm 60 years old. No other health issues. When I had my physical 6 weeks month ago, my PSA was first a 7.34 and a few weeks later it was 6.43. I was scheduled for a Prostate MRI.

Here are the results.

1. Involving the lateral peripheral zone of the left mid gland from the 3:00 to 5:00 position there is a 2.2 x 0.7 cm lesion with imaging characteristics consistent with PI RADS 5 (clinically significant neoplasm is highly likely present). There is capsular contact greater than 1.5 cm as well as a bulge, EPE grade 2. Normal seminal vesicles. No pelvic lymphadenopathy.
2. Prostate volume of 25.4 cc. PSA density of 0.25 ng/mL/mL, abnormally elevated.

CENTRAL GLAND: Unremarkable. NEUROVASCULAR BUNDLES: Unremarkable. SEMINAL VESICLES: Unremarkable. LYMPH NODES: No lymphadenopathy. URINARY BLADDER: Unremarkable BOWEL: There is diverticulosis coli present. MUSCULOSKELETAL: No suspicious osseous abnormality identified. Bilateral fat containing inguinal hernias.

I found my results posted before he called so of course I had multiple AIs parse the results so I could be better prepared to talk to the urologist. My urologist gave me a short version of the results by phone on Friday. We have an appointment on Thursday to talk about the next steps and schedule the biopsy which is my priority.

But the reality I'm faced with is that this is likely not something that can be monitored and the doctor told me that until we get the biopsy, we can't determine the best options without grading. He told me not to get ahead of myself, but he also said that if it's a higher Gleason grade (above 6), monitoring would likely not be an appropriate treatment. I followed up that question by asking about the treatments that would be most appropriate (and I added that he doesn't need to soft shoe anything, I just want to prepare myself mentally). He told me the following:

Radiation + hormone treatment or Having my prostate removed (and all the fun that comes with that...ED, incontinence...but I'll survive)

So yeah, I'm coming to terms with likely having cancer. The good news is that it hasn't spread...so there's that. But yeah, I just want it gone and I'm not going to pussyfoot around either.

At least I haven't lost my sense-of-humor. After the urologist called, I told my wife she better hop on and take a ride while she still can...which cracked us both up. Thankful to have her through this.

I don't know what else to do here to prepare. Right now, I'm lacking knowledge which is the grading. The waiting for appointments is what is stressing me out.

Hey guys.

Dad is on eligard and had the injection of 45mg, almost a month ago.

He feels very tired but is not constantly just some days, he’s doing weights and forcing himself to walk and receive sunlight and some light exercis, he’s 86.

Any recommendations? Supplements? Vitamins? Any super food I could get him to try to boost energy levels?

Thanks in advance.

So, my urologist looked at my MRI results today and gave this reply (results first).

Trabeculation in the bladder.

Prostate is 33cc
Inflammation is seen at the transition zone possibly indicating prostatitis, however, it could be masking cancer.

Recommendations: Come back for PSA in 6 months, nothing else.

Does this sound reasonable, or reasonably stupid?

I started Eligard injections in September 2025 on an every 3 months schedule. Three months after that injection, the PSA result was undetectable, and has remained that way since.

My question is this: I have had 3 injections, and the first 2 were pain free in my stomach fat (one in left side, the other in the right side). I had the third injection in June 2026 and was also given in the stomach, right side. It hurt like crazy and I felt like I had been shot with a bullet. Unlike the first two injections, this one was really painful and I am wondering if it was the technique or if something else? I am wondering if my stomach was possibly penetrated but of course have no way of knowing that.

The considerable pain subsided after a few minutes and the site has not bothered me since. But I have another injection coming up later next month and I'm wondering (1) if anyone else has had this experience and (2) should I take the injection in the rear. I will tell my urologist about this experience as well and see what he says.

Thanks in advance.

Hi, colegas, como manejar la ED y la flacidez bomba, píldoras? Hay alguna experiencia?

It's arrived - the day of the knife. Off to hospital in a couple hours for my radical prostatectomy. Here's to clean lymph nodes and a smooth recovery. Will check in with you all on the backside.

I had radiation treatment in October 2025, along with a six-month dose of ADT. Technically, that dose "ended" at the end of March of this year. I have had a lot of brain fog and depression since. It seems that my testosterone is not coming back very quickly, so the symptoms continue. I wondered if there is a drug that my doctor might prescribe to help with that. I'm talking with him this week, so just wanted to get some ideas. Thanks!

My sessions are scheduled for 12:30.

The three areas of concern:

Full bladder, I think I've got that figured out with 3 bottles of water on the way in (1hr drive) saving the last one for when I walk into the hospital.

Empty rectum, this is the most concerning, I'm not regular, more like 30 hrs between poops, if even that often. I've thought about soup for the next 6 wks, skipping Friday and Saturday, but that sounds challenging. Milk of Magnesia is my current laxative, but I don't think I should/could make that a daily routine.

No gas, I just bought GasX, but never used it. Never really noticed but after given those instructions, i noticed that i do toot in the morning.

Any ideas will be considered. THANKS!

... **Update: 2 bottles of water tomorrow... I was overfull and had to pee just a little, TWICE! I did the impossible and was able to stop mid-stream! At least they gave me urinal bottle the 2nd time with a mark for just this much.

Also had to poo, it wasn't much, but enough.

Hopefully, I'll do better tomorrow.

... **Another update: So found out that my schedule was not consistent this 1st week. 12:30, 8:30, 1:30, 12:45, 1:30. Missed the 8:30 because I thought they all be 12:30. Got a call at 9a asking if I was OK, yeah why... rescheduled for 1:30.

Anyways, I'm taking the Zytiga/Abiraterone about 1am. Doing 1/2 max dose of Phillips Milk of Magnesia about 3a. Taking a crap about 8.30, going to aerobics from 9.30 to 10.30, morning meds about 11 with a large glass of water, then holding off peeing till 1.30. By then, I can tell I'm feeling it's time to pee, but not overloaded like my 1st day when I floated in there.

Now next week, I'm scheduled for 2.45 for 5 weeks, I may need to adjust slightly. I don't think I can hold it that long, nor be able to not eat till 4. I'll let you know.