Advice on options please

User

Posted 23 Jan 2026 at 11:20

I have been looking at discussions on the forum for a couple of weeks now and it seems a really kind and generous forum and so I am posting to see if anyone might please share their wisdom and experience around treatment options.

My husband, 54, has recently been diagnosed with localised prostate cancer. He had no symptoms, but had a PSA test, which showed it raised at 4.85 and then another PSA around the same level so had an MRI. The MRI showed a diffuse area so they offered a biopsy, which showed cancer - Gleason score 7 (3+4). It is localised and no node or other involvement beyond prostate.

We feel very fortunate that it has been found early and that we have options, but with options come decisions, which is where it feels more challenging.

My husband has, in theory, been offered a variety of treatment options, including active surveillance, radiation, brachytherapy, HIFU, cryotherapy and a radical prostatectomy.

Given his age (relatively young), he's been advised against radiation therapy given the chance of it causing secondary cancers. We have also been led to believe that if he has the treatments that aren't surgery now, he will likely not be able to have surgery later or it will present greater risks.

It seems that the choice we are being steered towards is between active surveillance and a radical prostatectomy.

To provide some context, there is a history of cancer within my husband's family - both his parents died of cancer relatively young (very early 60s and 70) - his father of oesophageal (having had mouth cancer previously) and his mother of pancreatic. Given this experience of cancer, my husband is keen to have the cancer removed. Whilst the surgeon has advised there is no genetic connection between prostate cancer and the cancers my husband's parents had, I have read that there can be connections genetically between prostate cancer and pancreatic cancer meaning that prostate cancer can be more aggressive where there is the genetic connection - additionally, his parents are from a part of Spain where a particular BRCA1 founder originates, which seems to be linked with this. I appreciate I may be worrying unnecessarily (and it may be a case of a little bit of knowledge is a dangerous thing!) and my husband has never undergone any genetic testing re cancer, but I guess we both feel that with the outcomes his close family members have had with cancers and given we have been advised he will need treatment at some stage even if he undergoes active surveillance at this point, we are veering towards surgery. My husband has private medical care through his work and so has seen a surgeon who specialises in radical prostatectomies with CUP and who thinks, based on the information he currently has, that he can spare the nerves (I am not sure if this is the man commonly referred to as the professorwhocannotbenamed?). Given all of this and thinking it would be better to have surgery at a younger age and whilst the cancer is as small and contained as possible, my husband is leaning towards a prostatectomy rather than active surveillance.

I am sorry for the long post, but I would really welcome people's thoughts and advice around the choice between active surveillance and a radical prostatectomy – both in terms of personal experience and in terms of anything we may be failing to consider / unaware of.

Thank you very much in advance.

User

Posted 23 Jan 2026 at 11:20

We feel very fortunate that it has been found early and that we have options, but with options come decisions, which is where it feels more challenging.

My husband has, in theory, been offered a variety of treatment options, including active surveillance, radiation, brachytherapy, HIFU, cryotherapy and a radical prostatectomy.

It seems that the choice we are being steered towards is between active surveillance and a radical prostatectomy.

Thank you very much in advance.

User

Posted 23 Jan 2026 at 12:09

Hello.

I'm sorry to hear that your husband has prostate cancer. However, it's fantastic that you are supporting him, and that you've found 'our club'. Welcome to the forum.

It is a brilliant first post.

Here is a link to an excellent video which describes the treatment options and their possible side effects.

https://youtu.be/zYTU94-8pTc?si=1Z29_l8rbTwF6DHl

You appear to be veering towards surgery, which bearing in mind your husband's age, seems sensible.

Here's another video which specifically focuses on surgery and is well worth viewing

https://drive.google.com/file/d/1fyYTLZpxnB9HaR7O4xQ5Ff58Pj4Cn6ZB/view?pli=1

If you decide to go for robotic surgery you are right in focusing on a very high level surgeon who can perform the Rolls Royce of RARP, which involves Retzius-sparing, CUP and Neuro-safe.

Whatever you decide, I wish you the best of luck.

You dilemma of going on active surveillance or opting for more radical treatment, is difficult.

There is no disputing that all over the world active surveillance is becoming more popular and is now deemed suitable for low volume, low grade, Gleason 7(3+4)' especially with low PSA and when it is safely prostate confined.

https://www.cancer.gov/news-events/cancer-currents-blog/2022/prostate-cancer-active-surveillance-increasing

If you read my profile you'll see I started on AS. Unfortunately, my disease progressed and I ended up having RARP.

This forum is heavily biased towards poorer outcomes, and in my opinion is biased against AS. My AS failure was nearly as bad as it gets, it left me with Gleason 9 (4+5) and capsular breach and T3a staging. If anyone is shouting, "Don't risk active surveillance", it should be me, but I'm not.

Like any treatment it has its horror stories, but try not to be influenced by individual disasters and look at the bigger picture.

Very, very few on here, recommend active surveillance. Occasionally, you'll get someone post, "I've been on AS for 10 years and everything is still hunky-dory." but such posts are disportinately rare.

People should bear in mind, that most blokes who've found AS a great success, will never have the need to join this forum. They'll be too busy getting on with their relatively unaffected lives.

I believe about 40% on AS end up needing further treatment. However, about 30% of those who've had surgery, radiotherapy and HT and other treatments, also end up needing further treatment. They get biochemical recurrence, requiring salvage treatment.

Treatment options are a very personally thing. Each individual will have different priorities and expectations. Some will be risk takers others will play it ultra safe. Unfortunately, the truth is, no matter what you decide, you can never be sure of the outcome.

Once again thanks for posting, sharing your husband's treatment path will be a great help to others. 👍

Please keep us updated.

Edited by member 23 Jan 2026 at 14:27 | Reason: Additional text

User

Posted 23 Jan 2026 at 12:24

I was diagnosed at 53, due to the stage of my cancer I was offered one treatment plan and so far it has worked. I'm not medically trained, so these are just my opinions.

You are making choices between the most aggressive (surgery) and least aggressive (AS) treatments. The psychology of most men leads them to choose much more aggressive treatments than they need to. It is quite likely your husband would have a more satisfactory outcome from radiotherapy.

I think he needs the genetic test. If he is genetically susceptible to cancer, then yes that would switch me to thinking that surgery is justified.

Dave

User

Posted 23 Jan 2026 at 16:25

Sunshine, if you look back though my profile it will probably put you off any treatment ☹️. Remember forums like this has alot of guys with issues. Something like 60-70 percent of men have a successful treatment and perhaps don't come on forums or they soon drift away. A few weeks after surgery I was back to my new normal. I was supposedly non nerve sparing but things were stirring and boy we were having fun finding a solution.

Had we had a screening program 12 years ago, I probably would have been in that 60-70 percent who have successful treatment. I don't regret having surgery, my salvage RT did do more damage than my surgery.

Hope all goes well whichever route you choose.

Thanks Chris

User

Posted 26 Jan 2026 at 11:48

Thank you very much for sharing your experience. I am keen to hear a variety of experiences so I welcome hearing about your experience, although I'm very sorry to hear that it sounds like you've had a rough ride. I'm really glad to hear that despite being non-nerve sparing things are still 'stirring' - that's obviously a not insignificant concern for my husband. And, thank you for the reminder about the fact that many people will have successful treatment and move forward without being involved in forums like this.

Thank you again for sharing your experience. It is much appreciated.

User

Posted 26 Jan 2026 at 17:41

Hi Simon

Thanks so much. That is really great to hear. I am very pleased to hear that you are doing so well post op and remain cancer free.

Thank you for your message.

Amy

Edited to add - thanks for the other message - I am not permitted to direct message people yet as a new member apparently, but noted and appreciated.

Edited by member 26 Jan 2026 at 17:44 | Reason: Not specified

User

Posted 26 Jan 2026 at 19:05

Not sure where you got the CPG1 from Adrian?

When I put these results in it comes out as a 2?

Personally I prefer the nomogram's here: https://www.mskcc.org/nomograms/prostate

They give a 99% chance of 15 years none prostate mortality if treated.

The figures for 3+4 active surveillance average at about 3 years before treatment (according to Google).

User

Posted 26 Jan 2026 at 20:59

Originally Posted by: Online Community Member

I was leaning towards AS then surgery . I think AS is maybe kicking the can down the road . Who knows? I need to decide soon though as want to get on with my life.

Hi Mick,

I inputted your details on the CPG calculator and it came back the same as Sunshines's husband's advice.

BUT you'd better recheck it yourself. I have been known to make the odd mistake.🙄

User

Posted 27 Jan 2026 at 18:28

Hi Antoinette

Its not an exact science thats for sure

Hope alls well and good luck

Mick

User

Posted 27 Jan 2026 at 21:44

Sunshine, my best wishes to your husband and you. The point of diagnosis and being given options was probably more stressful than anything subsequent when I had chosen my "conveyor belt" and had to accept what happened.

The dilemma is that all the main options have similar overall outcomes based on historic data. They do though have different experiences you have to go through, and different side effects.

Surgery is tough short term - the fact the robotic procedures leave only small surface incisions make one forget how major it is. It takes a few months to recover, and you will have a catheter for the first couple of weeks and with most hospitals anti-clotting injections. The side effects range from nearly nothing for a few lucky folk, to long term issues of incontinence and/or erectile dysfunction.

Radiotherapy is easier (though not that easy) and usually is given alongside hormone therapy which makes it more effective. Recovery is quicker. There are short term side effects from the radiotherapy, like tiredness and bowel sensitivity. The lack of testosterone during hormone therapy means low libido, a tendency to put on weight, and various other issues and a fair proportion of patients find those effects remaining after the treatment finishes. Long term (20+ years) there is risk of cancer in the tissues near the prostate that have bad some exposure to radiation, particularly bladder and colon.

Brachytherapy is another form of radiotherapy where instead of being exposed to a beam, radioactive pellets are inserted into the prostate. I haven't experienced that but some people on this forum have done well with it.

Active surveillance sounds like doing nothing, but since they are keeping tags on it it actually means doing one of the above once it is clear the cancer is progessing. That means having a few years without suffering any of those side effects, and if you are lucky and your situation remains stable that delay could be quite a long time.

Another thing people take into account is what happens if the cancer comes back (PSA increase). If you have had surgery they can still radiate the nearby areas where any remaining cancer cells might be, if you have had radiotherapy first time it isn't often possible then to do surgery.

The usual advice is for surgery if younger and radio if older. I think the argument is that after 70 the risk of cancer in your nineties is less of an issue plus your body may take a lot longer to recover from surgery than a younger patient. But on the other hand surgery side effects of poor continence and/or erectile function may (arguably) be tougher to deal with in your fifties. AS delays side effects but for some people the anxiety is unbearable. No one else can say what is right for you.

The other thing I always add is: the statistics on recurrence over 10 years inevitably relate to the treatments as they were over 10 years ago. In that time things have improved. With surgery I think it is mostly more experienced surgeons and some tweaks to procedure but essentially the same operation; with radiotherapy a new generation of machines has been introduced which are better at focussing the beam on the target area and give less risk of cancer to nearby tissues. But we don't yet have the 10-year figures for those!

User

Posted 04 Feb 2026 at 05:10

Important thing now is set a reminder for the PSA and MRI then forget all about prostates.

User

Posted 04 Feb 2026 at 13:53

DO NOT RELY ON THE GP!!!

User

Posted 04 Feb 2026 at 14:56

I don't think GPs even see most blood results, PSA doesn't get flagged unless it's " not normal". When on AS any rise is not normal but it is unlikely to be picked up by GPs or their staff.

There have been countless examples of unqualified and inappropriate PSA results interpretation on this forum. I too have experienced it eg being told my PSA of 0.11 is "normal" even though I don't have a prostate.

User

Posted 05 Feb 2026 at 07:30

Hi, Mick

Such a sudden rise PSA will almost certainly be due to the tissue trauma and inflammation.

Show Most Thanked Posts

User

Posted 23 Jan 2026 at 12:09

Hello.

I'm sorry to hear that your husband has prostate cancer. However, it's fantastic that you are supporting him, and that you've found 'our club'. Welcome to the forum.

It is a brilliant first post.

Here is a link to an excellent video which describes the treatment options and their possible side effects.

https://youtu.be/zYTU94-8pTc?si=1Z29_l8rbTwF6DHl

You appear to be veering towards surgery, which bearing in mind your husband's age, seems sensible.

Here's another video which specifically focuses on surgery and is well worth viewing

https://drive.google.com/file/d/1fyYTLZpxnB9HaR7O4xQ5Ff58Pj4Cn6ZB/view?pli=1

If you decide to go for robotic surgery you are right in focusing on a very high level surgeon who can perform the Rolls Royce of RARP, which involves Retzius-sparing, CUP and Neuro-safe.

Whatever you decide, I wish you the best of luck.

You dilemma of going on active surveillance or opting for more radical treatment, is difficult.

https://www.cancer.gov/news-events/cancer-currents-blog/2022/prostate-cancer-active-surveillance-increasing

If you read my profile you'll see I started on AS. Unfortunately, my disease progressed and I ended up having RARP.

Like any treatment it has its horror stories, but try not to be influenced by individual disasters and look at the bigger picture.

People should bear in mind, that most blokes who've found AS a great success, will never have the need to join this forum. They'll be too busy getting on with their relatively unaffected lives.

Once again thanks for posting, sharing your husband's treatment path will be a great help to others. 👍

Please keep us updated.

Edited by member 23 Jan 2026 at 14:27 | Reason: Additional text

User

Posted 23 Jan 2026 at 12:18

Thanks so much for the warm welcome and for the links to the videos - we haven't seen the second one so will definitely watch that before the next appointment with the surgeon.

We have another appointment this week following the MDT and the surgeon viewing the MRI himself (for the initial appointment he was working from the report.).

I will keep the forum updated on progress as we make this journey.

In the meantime, other helpful links and thoughts are very welcome and very much appreciated.

Thank you again

User

Posted 23 Jan 2026 at 12:24

I was diagnosed at 53, due to the stage of my cancer I was offered one treatment plan and so far it has worked. I'm not medically trained, so these are just my opinions.

I think he needs the genetic test. If he is genetically susceptible to cancer, then yes that would switch me to thinking that surgery is justified.

Dave

User

Posted 23 Jan 2026 at 12:38

Hi Dave

Thanks so much for your response.

I'm glad to hear your treatment plan is working so far.

I think you're right possibly about men tending towards the most aggressive treatment and, I expected this would be the case for my husband, especially because of having lost both his parents to cancer. The radiotherapy he has been advised against given risk of secondary cancers - possibly because of his family history.

I am inclined to agree re the genetic testing, although I am not sure they will do it given they say there is no connection between the cancer types. I guess I am thinking that whether he has a BRCA1 cancer gene or other detectable cancer gene, the fact he lost both his parents to cancer (and various other family members - I just detailed the closest two) makes us both inclined to think that his genetic disposition is such that it might be better to go for the more aggressive option earlier. I hope that doesn't sound too negative - we're trying to be pragmatic and I guess whatever statistics there are, you go on your personal experience.

I realise as I write this it reads as though we are definitely decided on surgery, which I think my husband is, but I really am keen to hear others thoughts and I definitely think it is worth pausing to consider the extent to which psychology and experience is informing everything over rational thought.

Thank you again. I really appreciate it.

Amy

User

Posted 23 Jan 2026 at 12:56

Hi again, Amy.

Just to let you know, rather than doing another post. I've added more to first my reply on you wanting.opinions on the AS or surgery query.

Edited by member 23 Jan 2026 at 12:57 | Reason: Typo

User

Posted 23 Jan 2026 at 13:30

Thank you so much for the additional information.

I am very sorry to hear that your cancer progressed and very grateful for your sharing your experience and your measured perspective. It is very helpful to be reminded that those on AS without issues probably aren't posting here...

There is a lot to weigh up and I really value the shared experience of those further along this road.

Thank you

User

Posted 23 Jan 2026 at 14:00

Firstly, good luck to you and your husband on this journey. Tons of good people here with a real variety of experiences.

As regards treatment, I'm slightly biased in favour of Brachytherapy LDR. I won't repeat all my details here, please have a look at my profile and posts. Brachytherapy was a positive for me because it was one day of treatment and then home. Only one follow up scan at hospital and PSA tests done at my GP surgery.

Good luck with making a decision, feel free to fire off questions if you need to.

All the best.

User

Posted 23 Jan 2026 at 14:14

Thank you very much for your message.

I am keen to hear about as many different experiences of the different treatments as possible so will definitely have a look at your profile and posts - once I can work out how to do so! I am really glad your treatment has been a positive experience.

Thanks again for sharing information about your experience.

User

Posted 23 Jan 2026 at 16:25

Hope all goes well whichever route you choose.

Thanks Chris

User

Posted 23 Jan 2026 at 20:18

You should ask for more information especially about how much patten 4 cells there are. How many cores were positive. How long the longest length of cancer was. If there are any other risk factors involved like PNI or cribriform patten

GG7 doesn’t necessarily need radical treatment. Active surveillance could be a very suitable option. Maybe allowing many years of normal life before needing more than being monitored.

User

Posted 26 Jan 2026 at 11:48

Thank you again for sharing your experience. It is much appreciated.

User

Posted 26 Jan 2026 at 12:01

Thank you, John.

You're right that there is more information that is likely important to consider when weighing up options. Having looked at the report again, it says:

3 out of 24 cores positive.

Maximum tumour length 2.3mm

10% Gleason 4

Cribform pattern 4: absent.

(I couldn't find reference to PNI.)

All of this, I think is relatively positive, but obviously this is all very new to us so we're still catching up on the terminology.

It is so difficult to try to weigh things up rationally - we were told he would need treatment at some stage and so it is trying to work out whether he can live happily knowing he has cancer without it being immediately treated and also considering the potential benefits of undergoing an operation at a younger age and when the surgeon thinks (on what he knows from the report) that it can be nerve sparing.

I think part of it is the word cancer, which is so weighted, particularly given my husband's experiences with his close family members - if we had just been told he had an issue with his prostate that could be monitored and would need treating at some stage without that word being mentioned, I suspect our thinking might be quite different. What he does know is how much he would regret it if he went for active surveillance and then things progressed in such a way that his options changed. Our kids are still relatively young and he wants to limit any impact on them as far as he can.

Thank you so much for your perspective. I cannot tell you all how helpful and valuable I am finding everyone's contributions.

Amy

User

Posted 26 Jan 2026 at 13:34

Seems similar to me, my info on profile. Well except the decade in age which would definitely make a difference.

PNI is perineural invasion, refers to the presence of cancer cells growing inside or alongside nerves within the prostate. Can be a way out for the cancer cells. It is found quite often in biopsies.

Treatment or not is a very personal choice. I don’t think the risks associated with treatment should be discounted lightly. There are those who have no choice but to start treatment immediately. The more fortunate of us can take time to really think about the options.

Trying to imagine myself 10 years younger I think I would be opting for surgery early. That’s the exact opposite of what I’m thinking now waiting on AS and having RT/ADT as late as it’s reasonably safe to start.

The decision is definitely a tricky one I wish you both success in whichever choice you take.

User

Posted 26 Jan 2026 at 13:47

Thank you very much - for the explanation re PNI and also for your perspective.

I do think that the kids being fairly young - 13 and 15 - is leading my husband to lean towards surgery in the hopes of nipping things in the bud, but neither of us are taking the risks and impact of surgery (even if it goes as well as it can) lightly.

Thank you again - it is really helpful and much appreciated.

User

Posted 26 Jan 2026 at 15:45

Your statement in the original post is spot on IMHO.

"Given all of this and thinking it would be better to have surgery at a younger age and whilst the cancer is as small and contained as possible, my husband is leaning towards a prostatectomy rather than active surveillance. "

Please remember starting AS at 54 with a G4 in the mix guarantees you will be having treatment at some point in the future.

User

Posted 26 Jan 2026 at 15:59

Thank you very much for your post.

We are certainly given to understand he will need treatment at some stage and given this, the question my husband has is, why wait? And, whilst we are not aware of any prostate cancer in his family, his father was not tested for it, but had his first brush with cancer in his early 50s (mouth cancer) and passed away from oesophageal cancer at 62 so it is hard to know what might otherwise have happened re his prostate (it might have been fine, of course!).

Thank you for sharing your experience on your profile. It sounds like you have had a bit of a bumpy ride, but I am glad to see it seems like you have had an extended period of being well.

I really appreciate your thoughts so thank you.

User

Posted 26 Jan 2026 at 17:31

Hi Sunshineb

A great detailed post. I saw the professor whocantbenamedonhere and never look back. I was quite concerned about surgery as it seemed quite involved, but the key is finding a high volume surgeon with a track record to back it up. the good news is in most cases is absolutely nothing to be concerned about the whole thing. when I woke up I felt like it was less trouble than having my tonsils out. obviously I had to take care of the surgical sites to ensure healing and also manage a catheter for two weeks. but it’s all stuff you just get on with a manage and when you look back, you’re pleased that you did. I’m now just over six years postop and doing silly calisthenics things in the gym and other stuff and thus far cancer free.

radiation is a good thing to keep as a back stop if there is reoccurrence and salvage radiotherapy is needed.

pleased I didn’t delay as I had a voice in my head telling me not to hang about. Post op histology supported this.

simon

Edited by member 26 Jan 2026 at 17:42 | Reason: Not specified

User

Posted 26 Jan 2026 at 17:41

Hi Simon

Thanks so much. That is really great to hear. I am very pleased to hear that you are doing so well post op and remain cancer free.

Thank you for your message.

Amy

Edited to add - thanks for the other message - I am not permitted to direct message people yet as a new member apparently, but noted and appreciated.

Edited by member 26 Jan 2026 at 17:44 | Reason: Not specified

User

Posted 26 Jan 2026 at 17:44

Hi, again SBTG.

I've put the details that you've given into the CPG calculator.

https://cambridgeprognosticgroup.com/result.php

Late edit. I inputted the wrong information and have deleted the full results and advice, as they were incorrect.

Edited by member 26 Jan 2026 at 20:30 | Reason: Deletion.of text

User

Posted 26 Jan 2026 at 17:48

Thanks so much for the information about the CPG calculator - that's really interesting - and encouraging. It's helpful to have some statistics to balance against the more emotional responses one has.

Thank you

User

Posted 26 Jan 2026 at 18:50

Originally Posted by: Online Community Member

It's helpful to have some statistics to balance against the more emotional responses one has.

That's very true. When you are making treatment decisions, it is wiser to research the outcomes of thousands of patients rather than individual outcomes. Especially when they are posted on forums which are heavily biased towards poorer outcomes.

User

Posted 26 Jan 2026 at 19:05

Not sure where you got the CPG1 from Adrian?

When I put these results in it comes out as a 2?

Personally I prefer the nomogram's here: https://www.mskcc.org/nomograms/prostate

They give a 99% chance of 15 years none prostate mortality if treated.

The figures for 3+4 active surveillance average at about 3 years before treatment (according to Google).

User

Posted 26 Jan 2026 at 19:17

Hi Sunshine

I am in a very similar position and predicament as you 3+4 .

I am nearly 63 grown kids and grandchildren 😄.

I am having an appointment tomorow with a consultant.

Ive been offered a multitude of choices.

Prosectomy

radiation and Hormone therapy

SABR

And a randomised trial 50% have Hifu Brachy or freezing ... 50% prosectomy

I was leaning towards AS then surgery . I think AS is maybe kicking the can down the road . Who knows? I need to decide soon though as want to get on with my life.

All the best i know how your feeling

Mick

User

Posted 26 Jan 2026 at 20:15

Originally Posted by: Online Community Member

Not sure where you got the CPG1 from Adrian?

Nor do I mate. Must be my sausage fingers.😁

My deepest apologises to you, Sunshine and her husband. Just like my school reports said, 'Must concentrate and try harder."

I've redone it.

"Your Cambridge Prognostic Group is CPG 2

The prognosis from a CPG2 cancer is good and the risk of dying of prostate cancer is low compared to the risk of dying of other causes.

The risk that the cancer may spread (metastasis) is also usually low. Immediate curative treatment may be of some benefit needs to be weighed against the risk of side effects and complications.

The alternative is active surveillance and then treatment if there are signs of change in the cancer."

Have you got a link to to the average being three years before men on AS need further treatment. I've done loads of checks specially on outcomes of men with Gleason 7(3+4). I can't find anything other than the risk of AS failure is greater for Gleason 7(3+4) than Gleason 6(3+3).

Edited by member 26 Jan 2026 at 20:32 | Reason: Typo

User

Posted 26 Jan 2026 at 20:31

Hi Mick. 3+4 diagnosis has such a wide scope the decision is a real grey area. I understand your swaying and rethinking of the decision. I’m the same. Hoping my first PSA monitoring result doesn’t throw me into indecision.

3+4 could be treated as very low risk if there is a low % pattern 4, PSA < 10, small tumour size and T1. Or almost high risk if 45% patten 4, PSA 15-19, large tumours and T2.

Edit. ProtecT was the main trial it was mostly G6 with 20% or so G7. It was also 15-20 years ago so with modern MRI imaging and much better surveillance not sure how reliably the data can be applied today.

Also how many of those on AS who them needed to be upgraded and get treatment was due to progression of the original diagnosis? The cause could be missed higher grade in the original diagnosis or new cancer growth.

Edited by member 26 Jan 2026 at 20:50 | Reason: Edit to add reply to Adrian

User

Posted 26 Jan 2026 at 20:59

Originally Posted by: Online Community Member

I was leaning towards AS then surgery . I think AS is maybe kicking the can down the road . Who knows? I need to decide soon though as want to get on with my life.

Hi Mick,

I inputted your details on the CPG calculator and it came back the same as Sunshines's husband's advice.

BUT you'd better recheck it yourself. I have been known to make the odd mistake.🙄

User

Posted 26 Jan 2026 at 22:42

Thanks John

On my letter i says 3+4 grade group 2 then SNMCT 1778899017

Then later .... MRI pirads 4 signal of the anterior transitional zone and left apical zone. positive biopsy on the right only. All Greek to me.

What are you thinking?

Thank you Mick

User

Posted 26 Jan 2026 at 22:43

Thanks Adrian

User

Posted 26 Jan 2026 at 23:04

Hi Mick my details are on my profile. If I was going to have surgery I think I would get it done now. No point in waiting to have surgery later.

As I am going for RT/ADT when time runs out for AS I think waiting for as long as the prognosis is the same as now is my best choice. Ten years BCR free sounds better when you are older.

For me the choice was made on low % pattern 4 and no real extra risk factors.

Just hope PSA remains around 13 for awhile.

How are you feeling about your choices?

User

Posted 26 Jan 2026 at 23:19

Hi John

Thank you I’m hovering between As one day and prosectomy the next… I do think (maybe wrong) getting rid maybe the better option. It seems when they sent it to the lab it’s often upgraded. All a bit of a lottery. Also just treating the tumour. You only need a couple of rogue cells . What’s Adt? I know someone who had hormone then radiation he was happy with that but difficult to re visit later down the line … hopefully enlightened tomorrow

thanks mate

User

Posted 27 Jan 2026 at 09:05

Hi Mick

It a totally brain blower. I sat down and reasoned that it’s fundamentally cancer at any stage so pathologically capable of metastasis although less likely at early stages. I originally had symptoms back as early as ~2013. Then June 2015 had blood in semen which set off alarm bells for me. Docs were adamant I was too young to have cancer. PSA started upward velocity July 2019. Moved to PSA bloods and 3T mpMRI then biopsy which came back T2C. Had it out Nov 2019 and never looked back since.

Had I been sure it was cancer back in 2015 I might have considered early surgery then…..but then again robotic surgery had only really been a thing since then and retzius sparing approach ~2017 and neuroSAFE shortly after. For me it made sense to get it out when there is high degree of assurance it’s local. Talking to my consultant a few years back I asked why PCa tends to develop in anterior (outside) area of the prostate. He said it isn’t fully understood but something maybe associated with gland type.

This is an interesting discussion with Prof Mark Emberton (UCLH) where he touches on the concerns around biopsy and potential mets(51m40m): https://youtu.be/Jigoy-1-aXw?

I guess this becomes more of a concern with repeated biopsies.

Hopefully at some point diagnosis will be possible using biomarkers and scans only.

It’s not an easy decision as I looked at all sorts including proton beam, laser, nanoknife and hifu. Hopefully all the info from all angles on the site will help.

Please shout us anytime if you have any questions etc.

simon

Edited by member 27 Jan 2026 at 09:24 | Reason: Not specified

User

Posted 27 Jan 2026 at 09:31

I am happy to help with your decision making, based on my own experience of 2 years active surveillance followed by brachytherapy in Feb '25.

You are welcome to PM any questions you may have.

Good luck with your decision.

User

Posted 27 Jan 2026 at 09:44

Androgen Deprivation Therapy (ADT)
Often call hormone therapy.
If getting radiotherapy often used with that to improve outcomes.

User

Posted 27 Jan 2026 at 10:41

Hi Mick

I hope your appointment today goes well and helps bring some clarity!

I totally appreciate your sentiment about wanting to get on with your life - it's quite distracting to have such a big decision to make.

Amy

User

Posted 27 Jan 2026 at 10:43

Thanks so much for sharing your experience, KPC.

Do you mind sharing whether you were Gleason 7 (3+4) and what caused you to move from AS to treatment after 2 years?

Thank you very much

Amy

User

Posted 27 Jan 2026 at 10:51

Morning folks.

This link specifically deals with the use of Gleason 7 (3+4) and AS. It covers everything, including suitability and outcomes, but it is lengthy.

https://pmc.ncbi.nlm.nih.gov/articles/PMC11034964/

User

Posted 27 Jan 2026 at 10:56

Thanks a lot, Adrian.

This is really interesting and I hadn't managed to turn it up in my 'research' so much appreciated.

I had only been able to find general AS info, which seemed to relate more to Gleason 6 (3+3).

Thanks again

User

Posted 27 Jan 2026 at 11:03

Unfortunately my husband, who is May 2025, was G6 AS, and we were both happy with that, after 2nd biopsy was vaguely suggested, and thank God he said yes, I'll do it, was then upgraded to G8, needs treatment.

Things are going OK. He is on Decapeptyl, either coping well or side effects haven't kicked in yet. We take each day at a time. We are safeguarding our love life ❤️. GP prescribed Sildenafil and he is using a pump to keep everything in good condition. He walks about 3 to 4 miles from home in the countryside, most days . We'll change to suit circumstances.

He will soon be booked in for RT and the plan is to cure. It hasn't broken out of the prostate.

Edited by member 27 Jan 2026 at 11:06 | Reason: Not specified

User

Posted 27 Jan 2026 at 11:12

Hi Antoinette

I'm really sorry to hear your husband's diagnosis was upgraded - thank goodness he had the second biopsy! It sounds really positive that it hasn't broken out of the prostate.

I am pleased to hear he's coping well with the side effects so far. I hope things continue to go well once he has the RT.

Amy

User

Posted 27 Jan 2026 at 11:39

Thanks Tech guy.

Very informative video especially as it seems if they just treat the tumour thats enough.

User

Posted 27 Jan 2026 at 11:58

There is also a monthly, I think, AS webinar hosted by prostatecanceruk. Online every second Tuesday of the month. You can sign up for it.

User

Posted 27 Jan 2026 at 12:48

Hi yes I think you have to just roll with it. Consultant said he didn't need to have 2nd biopsy, just a precaution!

The thought of HT is very daunting, but his PSA of 7.1 went down to 1.7 after 3 weeks, so the consultant, different one, was quite pleased with that.

I've researched anything that alleviates side effects and it's best we can do.

I think if you have choices, and I don't think he did, just getvas much information as you can to inform your choice. I wouldn't get too fixated on private care either: a lot of consultants work in both sectors

User

Posted 27 Jan 2026 at 14:11

I was diagnosed at Gleason 3+4, T2, no metastasis (on bone scan). My PSA at diagnosis was 3.1 but an extended family history (Father, Uncle and, later diagnosed, brother) made the GP recommend MRI which led to biopsy and diagnosis.

I was placed into the AS programme, having PSA done every three months. We agreed that if it rose above 4.5, I would enter a treatment programme, with the consultant at the time pushing for an operation. My brother was diagnosed after me, after getting a PSA test which returned at 6. He had the operation very quickly, but had pretty bad side effects. This was one of the factors that made me push for Brachytherapy.

My PSA rose above the agreed level and I decided at that stage to enter the Brachytherapy programme. I had the treatment in Feb 2025.

My one year update can be found here: https://community.prostatecanceruk.org/posts/t33157-One-year-post-Brachytherapy-update

Edited by member 27 Jan 2026 at 14:13 | Reason: Not specified

User

Posted 27 Jan 2026 at 17:00

Thankyou Sunshine and all

All went well . I had an offer to go on a 50/50 trial of either hifu's or Prosectomy . This has now been withdrawn

As there were 2 lesions and they only found cancer in one. Had a 10mm core of 4.12mm tumour Looking at the really informative video that Techguy put up on this thread, by Doctor Emberson (if it looks like cancer then it probably is.) They would want to do another biopsy on the negative side. to enable any HIFU. Not doing that🤬. In that video he says how unreliable biopsys are you could biopsy the same prostate ten times and the results would be different every time.

Probably going to have it out now especially with the possibility of another unproven tumour. Video well worth watching.

User

Posted 27 Jan 2026 at 17:46

Sunshinebeyondthegrey

We weren't totally surprised and I hope have a reasonably positive outlook.

His father, also a very active chap, running marathons in later life, had prostate cancer in the 1980s, about my husband's age. He had RT which did give him a few unpleasant side effects. He gave up running and carried on long distance walking instead. He survived and died in 2001 aged 93.

User

Posted 27 Jan 2026 at 18:28

Hi Antoinette

Its not an exact science thats for sure

Hope alls well and good luck

Mick

User

Posted 27 Jan 2026 at 19:50

Mick 162

Something I have discovered is how varied the condition is and treatment has to be suited accordingly.

I think that's why everyone seems to be so different.

Our first experience with oncology team was dire. I'd go sofar as say his allotted nurse needs retraining. However the last consultant we saw I was quite impressed with.

I'm hoping we can see him again. He seemed to acknowledge us as people, not just a prostate with an issue on 2 legs with no brain, mind, or emotions

User

Posted 27 Jan 2026 at 21:34

Hi Antoinette

The consultant said they will never make a decision for the patient unless it’s like a Gleason 9. Then there’s only one option

User

Posted 27 Jan 2026 at 21:43

Well that may be but husband wasnt given any choice. He is actually ok with the staging hes got. But didnt seem to be any different options suggested.

The plan is to cure this. We've been convinced this is best option so we'll do the best we can. I have done huge amount of research, (I used to work in Reference and Information) and exercise and activity seem to be a good route. He did 8k steps today. He walks a neighbours Labradoodle most days, and loves that. We've got resistant bands and he's a very active chap

He's been doing Kegels with me on the Squeezy app, that's a brilliant resource! We'll just get through it as best we can together ❤️

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