The high Gleason, number of cores and high probability of seminal vessel involvement and extra capsular extension indicate surgery may not be the best option.
Another option is to take ADT3 hormones for a short time to stop the cancer while you research other options. It is likely you will have to take ADT3 anyway sometime in the future.
My opinion, that is not shared by many on this forum, is that if surgery doesn't have a high probability of curing your cancer and you will have to go to radiation or ADT3 then why have surgery and all the side affects that go with it on top of the side affects of radiation.
If you have seminal vessel invasion you have a high probability of lymphnode involvement which you will have to radiate anyway.
Oncas, I think you should see a prostate oncologist and a radiologist before jumping into a decision.
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 had BPH and not PC but to keep getting biopsies every year just in case.
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 was indolant and statistically insignificant, but PSA history 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.
Combidex MRI in 2-09 showed all lymph node clear.
Changed diet and takiing supplements while I wait, PSA dropped from 40 to 29 through diet alone. The location of the tumor next to the urethea plus the high psa make surgery an unlikely option.
Currently on Casodex and Proscar. Consultation with the radiologist suggested adding Lupron for 3 months before IMRT. May use a combination of seeds and IMRT. Radiologist and Oncologist will get together and come up with a joint recommendation next week.