I am 64 and evaluating two entirely different treatment paths for a T3b prostate cancer diagnosis. While my primary, non-negotiable goal is to completely clear the cancer and protect my life, I am also trying to carefully weigh how each treatment impacts my long-term quality of life. I currently have excellent baseline function, and being single, maintaining my physical recovery and long-term well-being is a very important factor for me as I look toward the future.
My PSA went from 5 to 7.8 over the last 3 years. Because of routine checkups, MRIs, biopsies, and TRUS ultrasounds, we thought this was moving very slowly. My doctor was actually quite surprised by the sudden spread outside the capsule. My full PSMA PET scan results are attached at the bottom of this post. (see below), but thankfully they show no signs of the cancer traveling to my lymph nodes or bones.
The Surgical Option (Dr. Peter Carroll, UCSF):
Had Truss/ultra sound today: Dr. Carroll looked at the ultrasound and noted: "The ultrasound does show the tumor pushing through the prostate capsule and going into the seminal vesicle on one side... If we do surgery we would need to resect part of the nerve bundle on one side as we need to try an excise the cancer completely."
Because the scan shows the cancer is restricted to that left posterior zone and one seminal vesicle, Is Dr. Carroll planning a partial nerve-sparing approach on the affected left side while completely sparing the healthy right side?
The Radiation Option: My other choice is external beam radiation combined with a targeted brachytherapy boost to that left side and temporary hormone therapy (ADT).
I am trying to weigh the immediate hit of a partial nerve-sparing surgery (knowing my healthy baseline gives me a good shot at a strong 1- to 2-year recovery) against the delayed, gradual long-term blood vessel scarring risks of a brachytherapy boost.
Has anyone here with a similar single-sided T3b diagnosis gone through partial nerve sparing? If you chose the brachytherapy boost route for a T3b tumor, how did your urinary control and erectile function hold up 3 to 5 years down the road?
I would greatly appreciate any insights or shared experiences before my follow-up appointment. Thank you!
PSMA/PET Results:
Prostate bed: Focus of radiotracer activity in the left posterior peripheral zone of the prostate with SUV max 7.4 with possible extraprostatic extension better evaluated on MR 8/31/2026. Low level radiotracer activity through the remaining prostate.
mi-T-stage: T3b (Single seminal vesicle involvement on the left).
Regional lymph nodes (mi-N-stage): N0 (No evidence of pelvic lymphadenopathy).
Bones / Distant Sites: Trace radiotracer avidity associated with 8 mm lucent lesion with sclerotic margin of the left posterior sixth rib with SUV max 1.9, favored benign osseous lesion... No definitive evidence of osseous metastatic disease.
