+1 for Fairwind's +1 of John T
I'd start with a multiparametric 3T MRI with endorectal coil read by a superb radiologist or a color doppler ultrasound read by Lee, Bahn or Ukimura. Most often - 80% of the time - it's really multifocal (tiny bits of cancer throughout the prostate), but even then, destroying the index tumor can at least slow it down. So will a year of ADT, although it's far from proven, and has many nasty SEs.
SBRT and HDR brachy monotherapy have excellent cure rates for intermediate risk PC, while providing the lowest rates of sexual and other SEs of any radical therapy.Intermediate-Risk Patients With Organ-Confined Prostate Cancer Have High Cancer-Free Survival Rate After Stereotactic Body Radiation Therapy
High dose brachytherapy as monotherapy for intermediate risk prostate cancer.
•3rd biopsy (4/2010):
PSA=7.3, prostate volume=55cc, 8 of 17 cores G6 5-35% involvement
•SBRT (5x8Gy) at UCLA, 10/2010 at age 57
•PSA since treatment:
+3 mos:3.9 +4 mos:3.5 +7 mos:3.0 +10 mos:3.7 +13 mos:3.6 +19 mos:1.18 +23 mos:1.29 +29 mos:.37
• Side Effects of treatment:
+2 wks: Grade 1 urinary & rectal last 1 wk
+1 yr: Grade 1 urinary last 2 months