As you can see in my subject line, I just joined the PCa "club" this week at the ripe old age of 40. I've never faced any health related adversity in my life, but decided to push my PCP for a PSA test this year because of family history. Well, my PSA came back at 19.1 (!) and it's been a whirlwind the last 3 1/2 weeks to say the least.
Anyway, I received my biopsy results this past Monday (results below) and CT and bone scans (performed yesterday, no results yet). I've been devouring everything I can about PCa including Dr. Walsh's book. I'm meeting with my urologist this Tuesday to discuss my diagnosis and start discussing treatment options. I want to be as prepared as possible with questions. My chief goal right now is validating the stage and organ confinement probability. There was no stage indicated on the pathology report, but the urologist says it should be T1c. Here are my questions:
1) My very high PSA and palpable (although benign) nodule would seem to contradict my 3+3 biopsy Gleason scores. Everything I've read in the last several days seems to indicate that this high of a PSA score equals a more aggressive malignancy. One item of note is that I did have a lung infection (bronchitis or pneumonia) for a month prior to my DRE. My urologist thinks that the infection may have elevated my PSA to this level. It seems like have another PSA datapoint is critical before making a decision about treatment options. How should I proceed with my urologist on this? Insist on another PSA after the effects of the biopsy have worn off? His indicated stage seems like more of a guess at this point. Is this typical?
Once I have a handle on this, treatment options will be considered next. Here are a few questions to get me started.
2) Assuming that this is organ confined, everything I've read points to surgery for someone of my age. Is this still the consensus or are the cure rates for radiation (brachytherapy, maybe with EBRT) really comparable? The posts I've seen on salvage surgery are a little scary.
3) Are there any advanced imaging technologies available which can determine whether nerve bundles can be saved prior to having surgery? I'm not really looking for probability or chart percentage, I'm looking for a clinical thumbs up or down for my case.
4) While I'm not unhappy with my currently urologist (never had one before and have only known him for two weeks), I'm going to be looking for other opinions. Does anyone have an recommendations for a highly experienced and skilled urological surgeon and a urological oncologist in the Rochester, NY area? My father had Dr. Jean Joseph who is one of the nation's expert Da Vinci surgeons, but that's about all he does. I want to consider all options at this point. I am going to attend a local support group to ask this question too, but I just thought I'd put it out there.
Thanks in advance for all of your help, this looks to be a great group of people.