Agressive Gleason 8s and 9s are sometimes associated with very low psa. I don't know why and maybe someone else can give us an explaniation.
So I would not use the low psa as a factor in your decision making. Getting a 2nd opinion from a prostate oncologist could help in better staging which would lead to a better treatment strategy.
Gleason 8s and 9s are agressive and the high reoccurance rate indicates that cancer cells enter the blood stream much more than they do in Gleason 6.
The only downside of surgery is the high risk of reoccurance coupled with living with the side affects of the surgery then having to go through another treatment. Surgery could work and it has for a lot of people. With a gleason 8 you should definately be looking at getting opinions from other doctors that are not surgeons.
I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%
I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.
in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.
2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.
Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.
Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.