Welcome to the forum, and sorry that you've joined the club. My numbers, age and active lifestyle are all similar to yours so I can relate...and maybe offer some food for thought.
First, let me echo what a few guys have already written - be prepared to be your own best advocate. I've been blessed to have great medical resources and have received great care. But...even the best PCa minds differ on some fundamental issues. You must educate yourself, weigh the advice and alternatives and be active in deciding your treatment options.
I was lucky enough to have had a robotic surgeon who has done more of these surgeries than anyone in the world. As a result (I believe) I had little or no surgical complications and I healed quickly including a fast resumption of my very active lifestyle. 6 weeks post op I visited with him and his advice was, based in large part on an undetectable PSA, to do nothing more "until the cancer returns". He explained that with positive margins and a Gleason 9 that it was likely to return eventually but that it might not, so he was not in favor of any additional treatment at that point. Initially I was relieved, but the more I thought about
it the less satisfied I was with watching and waiting - under my circumstances. So...read everything that I could (Dr. Patrick Walsh's book is a great resource) and sought out 3 additional opinions.
At the end of the day, 2 of the 3 additional opinions recommended radiation, supplemented by 6 months of ADT, to begin as soon as I was healed from the surgery. So...that left me tied 2-2 (counting my surgeon). My decision then was based on my mindset regarding the future. IF the cancer were to return sometime in the future, then I personally would be more regretful of having not done everything possible now to have prevented that day.
So last September I began radiation treatment and a 6 month course of ADT. I've had no significant side effects from the radiation - just an overactive bladder that should resolve itself as time goes on. The ADT on the other hand has been a little more challenging. Hot flashes, diminished energy and no libido...but I knew all this going in so it wasn't unexpected and is not intolerable. The radiation ended in December and my last monthly ADT shot was in February so I am eager for a return to a normal T level.
Since the post op PSA test I've had 2 subsequent tests and both showed no detectable PSA. Odds are that this would have been the case even if I had done nothing, but as I wrote earlier my decision was based more on the future and my mind set toward it.
Going into surgery I thought that was my last, and only, decision that I would be making about
my treatment. Had my Gleason stayed at the pre-op 7 (4+3) or if my margins had been negative than I would have gladly followed my surgeon's recommendation. But...circumstances changed and I had to adapt to them. I'm confident that I made the right decision for me (regardless of how things play out). Educate yourself now while you are healing so that you'll be prepared to do what is best for you when the time comes.
D.O.B 4/28/57 Age: 59
1/16 local PSA lab reading 5.4 (from 2.4 in 2015). PSA Re-test 3/16 = 5.5.
Local uro DRE revealed no enlargement and no lumps.
Biopsy DXd adenocarcinoma in 10/14 cores (many>80%).
Gleason 4+3=7. Perineural invasion noted.
CT abdomen, bone scan negative.
DaVinci prostatectomy 6/23/16 at Florida Hospital (Celebration. FL).
Surgeon - Dr. Vipul Patel (highly recommended).
Nerve bundles spared: 50% of left, 75% of rt.
Final pathology upgraded Gleason to 4+5=9 w/extraprostatic extension
Stage pT3a N0 M not known
Decipher score = 0.82 "Genomic High Risk"
4 lymph nodes, and seminal vesicles all negative.
Continence - very good (99%)
ED - present
Post-op exams 8/17/16: PSA <0.1
Post Edited (Gene Shue) : 4/30/2017 11:23:10 AM (GMT-6)