New To This Forum
Hi everyone,
I am new here and trying to learn from others who have faced a similar decision.
I am 59 and recently diagnosed with prostate cancer. My basic facts are:
- PSA in the 3-4 range
- Biopsy: Gleason 3+4=7 prostate adenocarcinoma
- MRI: PI-RADS 5 lesion in the right posteromedial peripheral zone
- MRI concern for extraprostatic extension near/toward the right neurovascular bundle
- Seminal vesicles normal
- No pelvic lymph node enlargement on MRI
- PSMA PET: uptake in prostate, but no radiotracer-avid lymph nodes or macroscopic metastases
- Decipher score: 0.96 high risk
I have talked with urology, radiation oncology, and medical oncology. My main decision is between:
Clinical trial path: xaluritamig plus/minus relugolix before prostatectomy, then surgery, with radiation/ADT still possible afterward if pathology or PSA requires it.
Radiation path: prostate radiation with MRI-directed boost, now likely including elective pelvic nodal radiation because of Decipher, plus about 2 years of ADT.
Surgery outside the trial: prostatectomy first, then early salvage/adjuvant radiation and/or ADT if pathology or PSA indicates it.
My concern is that the Decipher 0.96 makes surgery alone feel less convincing. I understand it does not mean surgery is wrong, but it seems to suggest aggressive biology and a higher chance that local treatment alone may not be enough.
For anyone with high Decipher, high-risk features, or EPE concern:
- Did Decipher change your treatment plan?
- Did it push you toward radiation + ADT instead of surgery?
- Did anyone choose surgery first and later need radiation/ADT?
- If you did radiation + ADT, how manageable was ADT after the first few months?
- Any regrets about surgery first vs radiation first?
I know Reddit cannot make the decision for me, and I am still working with my doctors. I am mainly looking for real-world experiences from people who had to weigh aggressive tumor biology, quality of life, and the possibility of needing combined treatment.