What's the best treatment for Gleason 7 prostate cancer - surgery or radiation?

I'm a gleason 3+3 psa 6.2. Right now I'm active surveillance. Waiting on decipher results. If psa rises I'm considering brachytherapy

All I can say is the Prostatectomy has resulted in severe incontinence. I kinda wish I'd tried the radiation approach first but 75% of my biopsy samples came back as cancerous, and genetic profiling showed them to be very aggressive.

How aggressive??

I am 67 diagnosed Q4 ‘24 with7.1 PSA and two positive biopsy cores 3+3=6 and 4+3=7 Gleeson scores. MRI clear with nothing suspicious. I chose 5 weeks external beam IMRT + one HDR brachytherapy session and 6 months Orgovyx ADT pills. First PSA post radiation dropped to 0.04 and I feel great but for a little lingering urinary frequency I had no interest in radical prostatectomy and the high risk of significant complications post surgery

I think I will go to surgery

Decipher score was the max of 1.0.

I was also Gleeson 7 and had surgery in 2016 and radiation in 2023. Having had both I would say it depends on your personal goals. If sex is important to you, surgery is going to be limiting for you and you might consider radiation or home hormone therapy. If your goal is long-term prognosis, you may choose a different approach. What advice are you getting?

It seems you’re headed for surgery?

I have my first appointment next Tuesday I will ask many questions about the treatments sex is important but is less important than be healthy

I was diagnosed June 2018 w 4+3, 10 PSA and over 25 metastases to my bones. So over 7 years on Lupron, jAbi n later Erleda. Doing great w a PSA of less than 1 the entire time. No libido but a great wife. Good luck! Chin up!

Bruce Iam glad to hear that but worst side effects I have family whit heart diseases Iam not sure it works for me how old are you???

Dear Julian G—My name is Dave Stauffer, of Denver CO. If I were in your situation, I would do nothing more than close monitoring. In August’23 I was diagnosed with Gleason 4+4, Stage 1, PSA 6.7, 0.83mm undifferentiated in one core, at age 74 and a super-fit athlete. I could literally write a book on this, but if my diagnosis were now I’d do no treatment. I’ve been harmed only by treatment, not cancer. You are young and not high risk. Read medical journal articles on over-treatment before you decide.

Hello Julian. My urologist is of course a surgery guy, so he recommended surgery, gave me the +’s of surgery over radiation. He also said to definitely go to the Radiologist for their opinion and gave me the card of the Dr. he recommends for radiation. I visited him and received his take on why he thinks radiation is the better option. After a few days of pondering, I chose surgery. If you do surgery, please make sure your surgeon is highly skilled with robotic ( DaVinci machine…quite amazing) surgery. My surgeon had done over 2500 robotic assisted prostatectomies. Surgery went great, I was able to leave the hospital that same night and drive home with the Cather and urinary waste bag attached. Urinary incontinence was a big concern, sex was not. After 8 days the catheter was was removed, and the Depends diaper was put on. Two weeks later I had about 90% of bladder control. 7 days later the diaper was gone and I never looked back. Yay, the nerve that controls the bladder sphincter was intact and I have 100% full control. Erectile nerve was not intact so that never came back, but at 69 years old, I really didn’t fret much. Post surgery, PSA was .17, but kept rising, so I started ADT ( androgen deprivation therapy) drug Orgovyx, and androgen receptor blocker Erleada ( aka Appalutimide). Very powerful drugs, frontline prostate cancer fighters. Side effects are real and most men experience them, hot flashes, fatigue, foggy brain moments, your Dr should tell you what they are. Some people tolerate them very well, others have a more difficult time. I’m a medium tolerant guy. But the drugs have been quite amazing, considering I was a Gleason 9, advanced cancer patient( biopsy of tissue after surgery……pre surgery biopsy read I was Gleason 7, intermediate cancer). I had positive margins in the prostate bed and one cancer lymph node infected. I had salvage Proton ( not Photon…..worth checking out the difference between the two) radiation, 37 treatments to the prostate bed and pelvic area to kill any remaining cancer cells, ……, ZERO side effects from the radiation. Anyway, 6 months later, PSA is <.01, NED(No Evidence of Disease) and holding. Not “cured”, but in full remission. Cured to me means off of all drugs and PSA is <.01 for 5 years, so my journey is far from over. Hope this helps a bit from hearing my condensed version of my journey. Please keep us posted.

Kevin Hill You got radiation after surgery??? Iam gleson 7 unfavorable is why Iam not sure if have radiation and hormones therapy or surgery??

Yessir, it is called “salvage radiation” because after the prostate was removed, there were traces of the cancer (margins they are called) left behind in the prostate bed and also because one of the lymph nodes of the 14 they removed was infected with cancer. So, in addition to the drugs I am now taking, it was highly suggested to radiate the prostate bed as well as the pelvic regions where the one infected lymph node of was. I believe it is the SOC (Standard of Care) to do this cleanup of any known remaining fragments of cancer cells/tumor. Hope this makes sense to you. Please don’t hesitate to ask any follow on questions. I highly recommend having a full list of questions written down and bring that list when you meet up with your doctor. And write the answers down. Ask how many robotic surgeries she/he has performed. Ask what percentage of operations preserved full erectile and urinary bladder control. What percentage of Gleason 7 operations he performed resulted in full remission, <.01 PSA for an extended period of time. I pray for you Julian, to help guide you through the decision making process and for a positive outcome! whichever procedure you choose. Godspeed sir.

Thank you

Just received my decipher test results today .58. I'm 63 and have no health issues. I was active surveillance but think with that score I need to discuss treatment options have appointment with oncologist to discuss options but I would be leaning towards brachytherapy. Surgery and adt are almost out of the question as far as I am concerned. Only symptom I have now is frequent urination has anyone had brachytherapy

I did brachytherapy non metastatic . Worst decision of my life Gleason 3-4 PSA around 6 that was 5 years ago The Dr never mentioned there’s a 15% failure rate which is huge The reason I picked it was that it seemed less invasive but once you do that they can’t do back because it’s kind of mush I’ve been on Zytiga and prednisone for over 4 years plus shot of Lupron 3 times a year. That’s the drug they give rapists I’ve gained 40 Lbs hot all the time and then there’s the heat wave like in menopause all night. I always said if I get cancer I’d get it cut out and blew it the going what I thought was the easy way. Hope that helps

Barry — I suggest you not feel so bad. I regret all the decisions I’ve made over 10 years with four major uro-genital procedures (including cancer treatments) … which did more harm than good or accomplished nothing—except making my subsequent procedures more difficult or ineffective. The problem is this: DOCTORS AND PATIENT LITERATURE LIE BY OMISSION. I mean that literally: It’s not that their words are lies. It’s what they DON’T tell you; e.g., the rate of failures … the likelihood of nothing bad happening if you do nothing. No revenue is generated by doing nothing, so nothing is almost never what’s done. And we’re left with ED, hot flashes, incontinence, regret, and resentment.

My name is Dave Stauffer, of Denver CO. If I were in your situation, I would do nothing more than close monitoring. In August’23 I was diagnosed with Gleason 4+4, Stage 1, PSA 6.7, 0.83mm undifferentiated in one core, at age 74 and a fit athlete. I could write a book on this, but if my diagnosis were now I’d do no treatment. I’ve been harmed only by treatment, not cancer. You are young and not high risk. Read medical journal articles on over-treatment before you decide.

Hi, my name is Willie. This is a decision only you can make — and I respect that. I just want to share a bit of my journey in case it helps. I had a robotic prostatectomy in 2016. When my PSA began to rise again, I underwent radiation in 2021. More recently, I started hormone therapy due to another increase in PSA. Interestingly, my PSA never reached 4 — but as you’ll learn, numbers don’t always tell the full story. One thing I’ve come to understand is that every individual’s experience is different. For example, many people I know who’ve gone through similar treatments have little to no issues with incontinence. That hasn’t been my experience — but again, everyone’s path is unique. Whatever you decide, make sure it’s based on what feels right for you, not just statistics or other people’s outcomes. You’re not alone in this — and there’s strength in knowing your body, asking questions, and trusting your instincts. Wishing you clarity and courage as you move forward. — Willie

Thank you so much Willie Iam agree about the recovery but is not easy decision because

Great post Willie. I'm six weeks removed from radical prostatectomy and I've experienced both incontinence and ED. Doctor says months to a year before it corrects itself.. but PSA is zero and I'm here for my family. I'll deal but everyone's experience is different

I just finished 28 radiation therapy treatments 2 weeks ago, and I'm experiencing all the known side effects. Very little energy. Im also on Lupron. My current PSA is 0.02. Being positive and laughing 😃 is the best medicine. My doctor & radiation therapy techs were amazing. I went to the Intermountain Cancer Clinic.

You will be good soon