Should I choose surgery or radiation for Grade 2 Gleason 7 prostate cancer?

Making treatment decisions can feel overwhelming, especially when both options have their own benefits and considerations. Many community members have shared valuable insights about their experiences with both surgery and radiation treatments, and connecting with others who've walked similar paths can provide helpful perspective as you weigh your options. Consider discussing the specific factors of your situation with your medical team, and don't hesitate to seek a second opinion if it would help you feel more confident in your decision.

I am about one month out from srbt. 5 radiation treatments over 2 weeks. Each treatment was equal to one weeks worth of radiation. Side effects were minimal they consisted of some loose frequent bm's that dissipated over about 2 weeks and some mild urinary irritation and frequency which is at a minimum as of now. Sexual function was not effected. So far the worst of the treatment was the dietary preparation of a limited food choice Mira LAX twice a day enemas the morning of treatment and timing the full bladder during radiation I had my treatment at Jacksonville Mayo. Not due for follow up visit and PSA test till October I am only sharing My experience not promoting a specific treatment cause I believe everyone will react differently to the treatment you have.

Dear Scott — I was diagnosed August 2023 with PSA 6.7, Gleason 4+4, Stage 1, single-core and had 42x EBRT + 4 mo ADT. I’m glad I didn’t do surgery, but what I most wish is that I had done nothing. I’ve had two years of persistent and increasing side effects involving numerous negative impacts on bowel, urinary, and sexual functioning that have made life consistently miserable and extremely frustrating with no help or understanding or encouragement of mis-named “Care Team.” A classic case of cure worse than the disease. At this point a cancer recurrence wouldn’t distress me at all, as the only thing it would interrupt is spending half my waking hours in bathrooms.

I also had grade 2 with gleason 3+4...My psa was 4.6....i had a prostatectomy in dec 2024...Did not want to to radiation and i am extremely happy with my decision...I never had incontinence...And knock on wood tomthis day my psa is undetectable....Yes I had ED....but i am almost where I need to be ...if u know what I mean...i feel great .good luck with the decision u make...

Hi Scott, I am facing the same decision same numbers as you and am probably going the cyberknife route. I just had two hernia surgeries and didn't want any more surgeries. I did try to get the TULSA procedure but nowhere would accept my medicare advantage plan. I have heard good and not so good outcomes for both surgery and radiation so it is a very personal choice. Good with your decision hope you have a good outcome.

It’s important to know your age and other factors such as your vitality. Have you had an MRI or a biopsy yet? I ended up having a radical prostatectomy. I am 63 years old, otherwise very healthy and athletic, biking regularly and doing weight training. I ended up having an MRI which indicated there was a lesion and then I had a biopsy, which indicated 4 of the 13 cores being 3+4; 5 cores being 3+3; and 4 being benign. They treat everything as seven, consequently. I also had a PSMA PET scan which indicated there was no spread, and that the cancer was localized within the prostate. I was given the option of having the prostate removed and also going the route of radiation and hormone therapy. Both would’ve been equally effective I was told. I elected to have the prostate removed. Everything was a great success and I’ve had two PSA‘s since the surgery last September and both have come back the best possible result, undetectable.

Do you have a family history of PC ? If so be vigilant. The pathology report if you do have surgery is the only way to know your true stage and whether localized or local. So I say this only as a future reference if surgery is chosen. I had 4+ 4 local first biopsy. Then 6 months later a 4+ 3 from my 2nd urologist who did biopsy and the surgery. The pathology was 5 +4 . Locally advanced. It can and will be complicated. Good luck forward.

I was also diagnosed with Grade 2 Gleason 7 (3+4) cancer and chose to go the hormone therapy process ( Elagard ) and SBRT 5 radiation. At the end of the treatment I was cancer free and still am 14 months later. As some have mentioned, it’s not too bad of a process except the daily prep before the radiation. Best of luck to you.

2025 my biopsy showed Grade 2 Gleason 7 (3+4), NCCN Favorable Intermediate. I was given a 3rd option, Active Surveillance. Given the potential for severe side effects of active treatment, I've chosen surveillance. Latest MRI shows stable. Have also employed other actions, eg, exercise, homocysteine, diet choices. Yesterday biopsy will give me next data point. Supplemented biopsy review with Artera AI review, which supported surveillance.

I am 76 years old and was diagnosed with Stage 2 moderately aggressive prostate cancer a little over 2 years ago. I had it in the upper left 4 of the 12 prostate quadrants. Like everyone else I considered several options from complete removal to radiation. After speaking with trusted medical doctors I opted for 2 doses of HDR Brachytherapy (not fun) over a 3 week period, fortunately with a world class doctor. My reasoning was I did not want to go to a hospital, get opened up and run the risk of sepsis. Also this treatment is so targeted with rods/catheters directly into the the prostate so one can completely avoid problems that EBRT can cause when the radiation accidentally effects bowels & bladders. My PSA over the last 2 years has consistently trended downward from 5 to .4 a couple of weeks ago. After effects have been minimum except for some testicular swelling, frequent trips to the bathroom at night only, and the whole sexual deal is in the rear view mirror. My only treatment now is 1 tablet of Flo Max daily in the evening. I feel good, strong, ride bicycles 2000 miles a year, swim daily, do yard work, etc. would I do it again-yes. I do not dwell on this at all except I do get a little nervous when I get my semi annual PSA Results. I view myself as a very fortunate cancer patient in recovery. Just wanted to share my journey to this point!