Worried about choices i have to make

Hi, mate.

Welcome to the forum.

At 67 years old, with a Gleason 6 (3+3), presumably T2 stage diagnosis, I can't understand why you haven't been offered active surveillance?

Here's an excellent video on various treatment options, more than just radiotherapy or surgery, and their possible side effects. 

https://youtu.be/zYTU94-8pTc?si=xW83bOb0AVFQFD2l

I can't see, in your case, that there is any rush to make a treatment decision, so you've got time to research thoroughly.

Please keep us updated. Good luck.👍

Edited by member 22 Aug 2026 at 07:28  | Reason: Additional text and add link.

Sorry to hear this.

please take a look at my journey. I was initially diagnosed Gleason 6 and went down the surgical route Nov 2019 at London Bridge (Guys Private). Still all clear after final staging post histology of (3+4) Gleason 7. T2 c. Quality of life pretty similar to pre-op so happy days!

Edited by member 22 Aug 2026 at 20:53  | Reason: Not specified

Husband is 74 and G8. He finished RT 4 weeks ago and is on HT.
About 20% of men retain sexual function to some degree on ADT. He is a fit mostly active man.
We haven't got up yet as he is making the tea. I'll leave the rest to imagination.
What is your biggest fear?
Impotence, or incontinence?
How old are you?
Would surgery guarantee to be nerve sparing?
Perhaps talk to someone on AS.

There is talk of reclassifying G6 as not a cancer. I can understand your anxieties though. 

The RT of 20 sessions was a strain but not unbearable he said. The going backwards and forward 5 x a week was a drain. He is virtually back to normal now.

I wish you well 

Edited by member 23 Aug 2026 at 08:45  | Reason: Extra info

Hi yes up and in the garden now.

The RT can have long term side effects but I feel the statistics are for men who had the treatment a fair while ago. The RT these days is more targeted.  Husband asked the GP for Tadalafil and she agreed . It can help with blood flow for erections, and there is a (disputed) idea that it helps prevent urinary tract damage by RT. It was very effective to the extent husband decided to only take 2 or 3 a week. (5mg) 

An American specialist Mark Schulz has done a lot of YouTube videos. I found the minimising side effects really helpful. He also has said RT is as effective as surgery. 

As Adrian said don't rush. This is not as urgent as it first seems. The word cancer is frightening but G6 is not life threatening as such. Find lots of info and go with what fits your personality best 

We had no choice. We also have my husband's father's experience. He had PC in his 70s and lived to be 93. So husband actually expected to have it and we weren't surprised. Dismayed and worried yes but moving forward as positively as we can.

Ps we still haven't told neighbours where we live. I thought we'd definitely need to during RT but no, we still didn't need to. He was very tired on 2 days, mainly because he'd walked 5 or 6 miles with a neighbour in 30° heat! Otherwise just getting on with stuff normally 

As Adrian56 says they should be offering you active surveillance as a first resort with your diagnosis - I was 3+4 & T3a so I was recommended surgery - my consultant told me if I had been T2 I would have been on active surveillance. Even with my diagnosis it took me 7 months to agree to surgery as I couldn't make up my mind what to do - my consultant was Ok with me taking my time to decide. 

I had the op in March - was fully incontinent when vertical after my catherter was removed - now 5 months later I have full control. Unfortunately I have no erections but as I had ED before the op I'm not surprised (but still disappointed). There are side affects of the surgery but my last PSA test was undetectable so from that perspective its worked. 

I found making the treatment decision the hardest part of all so take your time to be comfortable with your choice. 

There may be a further option for you if you are a suitable candidate but it is seldom mentioned because few hospitals can offer all or any forms of it. I am referring to Focal Threapy. The most common forms of this are HIFU (High Intensity Focal Ultra Sound) which kills cancer by heat, Cryotherapy, which freezes the cancer cells or Nanoknife (Irreversible Electroporation) which uses electricity. There are other forms of Focal Therapy but this would mean being treated abroad, so I will not detail them. Then there are two types of Brachyherapy which can be by placing radioactive seeds (Low Dose) or by inserting radioactive probes into the cancer cells and removing the probes almost immediately during an operation, (High Dose). Focal generally has fewer side effects but requires a specialist to check your suitability . HIFU may require two treatments. All the aforementioned treatments can be done on the NHS

https://www.youtube.com/watch?v=tkueqxHuVn4

https://www.youtube.com/watch?v=8h8tnVENMSY

Edited by member 23 Aug 2026 at 22:20  | Reason: to highlight links

I looked quite seriously at focal therapy back in 2019, as well as proton beam treatment. UCLH was one of the leading UK centres for focal therapy, and at the time I also had access to proton beam treatment privately almost on my doorstep.

After speaking to consultants and a number of former patients, I eventually decided it wasn’t the right route for me. One of my concerns was that prostate cancer can be multifocal, so treating only the known focus doesn’t necessarily mean there isn’t clinically significant disease elsewhere in the prostate, either already present but undetected or developing subsequently. In some cases that can mean further focal treatment, radiotherapy or surgery later on.

For me personally, I preferred surgery because I wanted the prostate removed while the disease appeared localised, while retaining radiotherapy as a potential salvage option should I ever need it.

Another factor in my decision was the possibility of the final pathology being different from the biopsy. Although my biopsy showed Gleason 6 disease, my surgeon advised me that in my particular case he estimated roughly a 60% chance that the cancer would be upgraded when the whole prostate was examined after surgery. That obviously won’t apply to everybody — upgrading risk depends very much on the individual case, biopsy findings, MRI, tumour volume and other factors — but it was something I had to take into account when making my decision.

I was also advised that surgery after previous radiotherapy or some focal treatments can be more technically challenging because treatment can cause scarring/fibrosis and alter the normal tissue planes around the prostate. Salvage surgery is certainly possible in experienced hands, but that was another reason I preferred to keep radiotherapy in reserve rather than the other way around.

One other thing that influenced me was that my cancer was very close to the edge/capsule of the prostate. I remember discussing the location with my consultant at some length, and that added to my feeling that I would rather deal with it sooner rather than potentially chase it later.

That’s just how I approached the decision in my own circumstances rather than a recommendation for anyone else. Surgery, radiotherapy, focal therapy and active surveillance can all be entirely reasonable choices depending on the individual cancer and, importantly, what matters most to the person having the treatment.

Unfortunately, that's not always the case, between 20-40% of those who've had surgery, have biochemical recurrence. The risk of BCR is dependant on my factors, including the aggressiveness of the cancer, but even those with low/intermediate grade cancer, have about a 20% chance of recurrence. I believe the recurrence rates are similar for other treatments.

Initially, I had a very similar diagnosis to yours. Gleason 6, T2a,  PSA 5.6. Statistically, I had a 50% chance of not needing further treatment in the following ten years. I liked those odds and took a chance. 

Unfortunately, during the following two years, they discovered disease progression and I opted for surgery. Three and a half years later, its been successful, but I still have a high chance of BCR. 

Although my active surveillance ultimately failed, if I were in your position, I'd still give it a go.

My reasoning for this is you've roughly got a one in two chance of not needing further treatment in the next ten years, and no risk of treatment side effects. Where as if you opted for surgery you've got a 1 in 5 chance of recurrence and a high risk of side effects.

The beauty of active surveillance is you can change your mind and if things go awry opt for a radical treatment. You say that you find it difficult going on active surveillance in case the cancer grew. I appreciate that, I had the same concern, but I find the checks for BCR just as worrying. 

My thoughts are why try and fix something that might never need fixing.

My only concerns about active surveillance is it being largely based on biopsy results which can be inaccurate. I believe that my initial biopsy missed the more aggressive cancer cells.

It must also be ACTIVE surveillance. You must ensure that your follow up PSA checks, MRI scans and possible biopsies are done in a timely fashion. Mine weren't.

I hope that your appointment goes well today and whatever treatment path is planned, it works for you.

Edited by member 24 Aug 2026 at 10:20  | Reason: Additional text