Your husband has two high risk factors, a psa over 10 and a grade 4 gleason; this would put him into a high risk catagory. Bone and CT scans won't show anything at this point, so you cannot rule out micro mets. The psa of 26 is very worrisome.
These are the things I would recommend:
Get a 2nd opinion on the biopsy slides from Epstien at John Hopkins and do a ploidy analysis.
Get a scan, either color doppler or MRIS to pinpint the tumor
location and evaluate extra capsular extension.
Find a doctor that uses the partin tables, neuronetworks and have him explain them to you and what they indicate. You want a probability that the PC is organ confined. If there is a low probability of organ confined disease then surgery would most likely fail.
Get a PAP and a PCA3 test. These can indicate possible micromets and agressiveness.
After reviewing all of the above with a prostate specialist, most likely a medical oncologist, then a treatment plan based on his condidtions can be recommended. Until you get this information you are only guessing.
You are in a fight with PC now and if you want the best chance of winning you must determine everything about
your enemy before you start fighting. Most battles are won before any fighting begins.
64 years old.
PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.
2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.
Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.
Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.
25 treatments of IMRT 6 weeks after seed implants. No side affects at all.
PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.