You have been given a lot of advice on this forum based on what others did and their results. These have little bearing on your individual situation as your PC is individual and has to be looked at as your individual PC.
There are things you can do to determine if it is local or not and this will definately affect your treatment options. Your high PSA, number of cores, and % of cores put you in an intermediate or high risk catagory as you already saw from the partin tables. This makes the treatment option highly important. In the low risk catagory the option you pick really doesn't mattter much.
1. MRIS with endorectal coil does a good job at spotting extra capsular penetration. This would be an important thing to know in choosing a treatment. This is offered at Hopkins and UCSF and maybe a couple of more places.
2. A good PC oncologist can use data from the biopsy, gland size and psa history and calculate how much psa is being generated by the tumor and the gland. If there is more PSA then it is likely coming from some where else. Other doctors can do this as the software tools are available, but few do. The good oncos always use these tools. He can calculate the probability of it being local or systemic, like the partin tables but with more information fed into the software.
3. If the probilility of it being systemic is high (your call, but my cut off would be 25%) a Combidex MRI to pin point lymph node involvement is very useful in tailering treatments.
The process is simple: Why more people don't do it is mystifying.
1. Determine the biology of your individual cancer with as many tests and software tools as possible.
2. Match the correct treatment to your particular biology (not someone else's) to give you the best possible probability of cure.
3. Pick the very best doctor in that treatment area.
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.