Hello and welcome, Karen, and your husband.
Forty five is young for a dx, but we have younger ones here too. My uro said I was one of his youngest patients, and I was 56 at my dx.
With you doing what you do for a living, having some inside knowledge on the radiation side, doesn't make the decision any easier.
The trouble wiith any PC dx with a biopsy, as you know, are you seeing the whole thing? did the biopsy miss it? (that happened to me twice) and am I seeing just the tip of the iceberg? At best, a biopsy dx. is just an estimate of what is going on inside.
Some would suggest using the color doppler imaging technology to see if it can a"see" the tumor and its extent.
It's not uncommon after surgery, as you said, that the Gleason and/or staging increases in the post surgery pathology. In others, of course, it stays the same. In rare offerings, it goes down.
On the surface, looks like your husband has most treatment options or even a period of AS available, but that is still a tough and personal call to make.
Wish you the best, and please keep us posted on your journey.
David in SC
57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.33rd Biopsy
: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3Open RP:
11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09Path Rpt
: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin