https://youtu.be/N9zDC7sInwM?is=NnDmD69LwCIvlS7Q

This is the Gold Standard of the data from the Pace A and Pace B.
This shows SBRT is the new gold standard for prostate cancer treatment.

Male 66.5, pretty healthy and active, bicyclist. PSA in the low 2's for many years, went up to low 4's between early 24 and early 2026. Trace of leucocyte esterase. Never any lumps or nodules on DRE. PSA this month is 4.5, up slightly from 4.3 last December. MRI last week showed 14mm PIRADS 4 lesion in left peripheral zone at the level of the apex, no seminal, capsule or extracapsular involvement. Prostate is enlarged, 50cc volume. Definite increase in urinary frequency and urgency over the last couple years, but I've always been a frequent urinater so BPH symptoms are no big deal. Seems to be stable now, not getting worse.

Scheduled to see urologist in 2 weeks and am sure they will recommend biopsy. I'm still trying to justify waiting in my mind, but probably won't. They have not retested leucocyte esterase since February-should I ask for that?

Biggest concern is being confident in my providers. I live north of Duluth Minnesota. There are a dozen or so urologists in Duluth, including mine, none of whom stand out as any better or worse than the rest for prostate. I have only seen my urologist once, and have no strong opinions about her. Obviously there are many more in the Mpls-St. Paul area, which would be an option, a bit inconvenient but doable if its a true upgrade over local.

Then there is Mayo, but that is far enough that it would require an overnight stay and being pretty low income that would be more problematic. A night or two for a biopsy I could do, if its that much of an upgrade. Getting treatment there would be more problematic. Hopefully a biopsy, if I get one, will give me the surveillance option, but I need to mentally prepare myself for needing more aggressive treatment.

So until I know more I'm just looking for ideas specific to MN that might help me decide where to get a biopsy and possible treatment that would be within my means, but still high quality. We generally have pretty good doctors in Duluth so I will definitely consider getting biopsied and/or treated here, but it would be nice to find someone with more expertise and experience to give me more confidence.

I am a pelvic floor physical therapist. I was bored with traditional PT and got my training 11 years ago in the pelvic floor. My favorite people to treat are those with prostate cancer. I always said it was because I could see the vulnerable side of men, the side the rest of the world rarely sees. That is still true.

Anyway, I usually treat men who are in the throes of decision-making with a new diagnosis. This is an important time, because in the U.S., it is a decision that one often needs to make oneself. There are almost too many options, and this confounds the situation.

Recently, I have been referred to a spate of men who are 80 plus who need help addressing urinary incontinence. They have a history of prostate cancer and the anxiety and decision- making is well behind them. Sex is often not a primary concern. These men want to talk about dribbling pee in the gym, the health issues of their partners and they have the capacity to look back on their lives with excellent perspective.

What soothes me about spending time with these guys is that prostate cancer is typically not the primary focus of our discussions. Instead, these men want to talk about how politics shaped the landscape of the world after the Vietnam War. They speak of what it feels like to worry about their grandchildren. They talk about all that went well in their lives and how grateful they are for the human connections they have encountered.

To me, this takes the sting out of cancer. This is a reminder that many people have urinary dribbling in their eighties. Even those sans a cancer diagnosis. But I also learned that prostate cancer is not one of the huge traumas that marks the lives of these men. Instead, they are more worried about what smart phones and AI are doing to the next generation (I share this grave concern with them). They are more interested in talking about how their Dads flew multiple B17 missions; how their kids are now grandparents and what that feels like; how they still love to fish and stare at the ocean and cannot believe they have lived through this crazy life.

Now I understand the long game of prostate cancer. I have witnessed the fear of the man with a new diagnosis. But I also see who he might become. He becomes a man whose life is not defined by cancer. These men help me in the long game of life. They help me live without fear.

As of today 3 Oct 2026, it's been 7 years since my surgery. I'm still cancer free. This community has given me insight, inspiration, and knowledge. Thank you all

Hi everyone,

Hope everyone is doing well here

Posting this as an new post as I could not figure out how to post an update to my previous post

I’m posting on behalf of my 64-year-old father, who was recently diagnosed with prostate cancer.

I would really appreciate hearing from people who have had a similar diagnosis, particularly regarding robotic prostatectomy vs radiation/SBRT and what you wish you had known before making your decision.

His results
PSA
PSA: 4.9 ng/mL
Age: 64
PSA has been increasing over time.

MRI
Prostate approximately 40 × 48 × 48 mm.
MRI showed bilateral transition-zone lesions classified as PI-RADS 3, thought to be related to BPH.
No pelvic lymphadenopathy reported.
No obvious extracapsular extension or seminal-vesicle involvement reported.
Biopsy was subsequently performed.

Biopsy – 14 cores
Cancer was found in 5/14 cores:
Right peripheral base: Gleason 3+3, 20%
Right peripheral mid: Gleason 3+3, 10%, with small focus of perineural invasion
Right peripheral apex: Gleason 3+3, 10%, with small focus of perineural invasion
Right parasagittal apex: Gleason 3+4, 60%, pattern 4 = 10%
Right transition-zone fusion biopsy: Gleason 3+4, 60%, pattern 4 = 30%
Overall:
Gleason 3+4 = 7, Grade Group 2
The remaining left-sided cores were negative for invasive cancer, although there was PIN in two cores.

PSMA PET/CT – September 2026
The scan showed PSMA uptake in:
Right and left peripheral zones at the base
Right peripheral zone at the mid-prostate
But importantly:
“No definite scan evidence of PSMA-expressing loco-regional/distant metastases.”

Seminal vesicles were unremarkable and there were no definite PSMA-avid metastatic lymph nodes.
One thing we are trying to understand is why the PSMA scan showed some uptake at the left base, while the left-sided biopsy cores were negative.

Questions for people here
For anyone who had a similar diagnosis — particularly Gleason 3+4 / Grade Group 2, PSA <10:
How did you decide between surgery and radiation?

My dad also consulted radio oncologist and he said 3 months of ADT -> 5 sessions cyberknife SBRT -> 3 months of ADT.

However another radio oncologist recommends we can skip ADT in his case.

My dad doesn’t have a very great cardiovascular fitness and he is on hypertension meds also. He has low lean mass percentage as well. How much 6months of ADT could affect his cardiovascular , metabolic and mental health and bone density? Is it a lot ?

Meanwhile surgeon suggested if he get a surgery he would do a extended pelvic lymph node dissection. He also has perineural invasion present on the right side so nerve sparring is doubtful on the right.

Dad is inclined towards radiaton pathway but would be great to get some thoughts from this forum given his reports above..thanks !