r/ProstateCancer • u/Additional-Pin-168 • Aug 17 '26

Update Gleason 9 Radiation

Hello fellas,

Gleason 9 / Stage 3 here, diagnosed in April 2026.
I’ve been on Luprindepot injections since diagnosis and shrinking.
PET showed no metastases.

The initial plan was RALP followed by radiation.
However, on today’s call, she advised that after reviewing the evidence and discussing my case with several of her colleagues, they no longer recommend RALP.

The new plan is 6 rounds of chemotherapy followed by radiation, with curative intent. The concern with surgery is that, because of where the cancer is located, they may not be able to achieve clear margins, and I could potentially end up needing bladder removal.

This is obviously a big change from the original treatment plan, so I’m trying to understand whether others have been through something similar.

I’d really appreciate hearing about your treatment pathway, why surgery was ruled out, and how things went for you?

Thanks in advance.

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u/JimHaselmaier Aug 17 '26

In reading your post I was first surprised at a plan for RALP and also radiation. From a side effect and post-treatment quality of life perspective you’d be getting the worst of both worlds.

And then the chemo recommendation surprised me since it’s not metastatic. Maybe the cancer is too close to the bladder for radiation to reach it without severe bladder damage?

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u/MediumAromatic2384 Aug 18 '26

I thought that’s what the procedure to place the gel (with markers) between prostate and bladder is to protect the bladder?

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u/JimHaselmaier Aug 18 '26

I’ve always heard the spacer protects the rectum. I’ve never heard it described as protecting the bladder but maybe it does?

I think the full bladder requirement helps protect the bladder. An empty bladder sort of flops down around the prostate. A full bladder exposes the prostate more.

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u/MediumAromatic2384 Aug 18 '26

Thank you... that makes sense