Good morning, Renee. I hope I can provide some helpful responses.
Prostate size is reported in "cc's" (cubic centimeters). During the biopsy, the doctor uses an ultrasound to get several dimensions of the prostate, then uses a complex 3-dimensional formula based on the typical shape of a prostate to calcuate an estimated volume. 23.1 would be a fairly normal sized prostate...which is about the size of a walnut.
The aggressiveness of the samples found in the biopsy, as indicated by the Gleason score, is low, which is a positive factor; although one always has to keep in mind that a biopsy is simply a sampling. Each sample represents only about 0.1% of the prostate.
With the number of cores positive for cancer, and the percentages of cancer in those cores, you husband would not be a good candidate for Active Surveillence, which defers treatment for a little or a long time (or forever). An aggressive treatment would be appropriate, but that doesn't mean that it need to be rushed-into tomorrow. Prostate cancer is different from other cancers and is generally slow growing. With the understanding that aggressive treatment would be appropriate, one should move deliberately, but not rush, into a treatment decision.
With surgery, the experience of the surgeon is generally considered to be the most important factor to consider. There is a well documented "learning curve" in the surgical proceedures to remove the prostate, and you would want to find a surgeon who has performed many hundreds of prostatectomies.
I hope this answers the questions you raised. Please don't feel the need to panic, but do help your husband to move forward deliberately with an examination of treatment options.
64 years old.
PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.
2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.
Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.
Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.
25 treatments of IMRT 6 weeks after seed implants. No side affects at all.
PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.