Sorry to hear about
the diagnosis. Gleason 9 is serious business, and if you've been surfing the net you're probably pretty freaked out; lots of scary stuff there about
it. The other cores you mention pretty much get trumped by the G9. They consider only the highest score.
What kind of MRI did he have? My 3T MRI with contrast was done after the biopsy, so some aspects of it were compromised. However, it pretty clearly indicated the cancer had extended beyond the capsule somewhat, that the cancer region is pretty large, and that the neurovascular bundles were involved. Biopsy showed perineural invasion of the G9 (5+4), also indicative of possible extension beyond the gland.
MRI results, I found that it's not always sensitive to see certain details, but if it does indicate something then it's quite likely to be there. Seeing extracapsular extension can be something of a judgment call with MRI, apparently. If it shows, then it's likely there. If not, then maybe not. Perhaps sometimes it's really clear, I don't know.
My urologist (high profile, thousands of surgeries) said he would do the surgery if I wanted to, and there was some small chance it would be curative, but not a very high probability. He would have to do a "wide excision", without doing "luxury things" like nerve-sparing and so on. He wasn't even making eye contact while describing it. I was interpreting this as assured incontinence and immediate 100% ED.
You might ask your urologist if he's considering a wide excision. That removes pretty much everything in the general neighborhood of the prostate, and is more likely to leave one with significant incontinence. I can't point to a study saying that, but it's my recollection from somewhere in the multitudes of studies I've looked through.
I didn't like the surgery odds, and ended up selecting IGRT by IMRT, along with hormone therapy, as my best shot at a curative option. We even radiated all the pelvic lymph nodes, since I had about
a 40% chance it had spread to them without being visible on the MRI.
Whether or not it's fully contained is a huge factor if considering surgery.
Tough decision, and all you can do is look at the available evidence, get opinions you trust, make the decision and go for it.
[Edit: Peter's comments are outstanding and he has made some great suggestions, as usual. These guys were a huge help to me a year ago when I was going through these decisions!]
IGRT by IMRT, 44 done 8/28/13: 50.4 Gy pelvic nodes, 79.2 Gy prostate
ADT2 3 yrs: Lupron/Casodex 5/1/13
Age 56: 55@Dx 4/16/13-
Bx 6/12 pos G9=5+4 (80%, 60%), 4+5 (2 at 100%, 80%, 10%), PNI+
3T MRI: Bilateral EPE, NVB+, SV-, LN-, cT3
Date PSA fPSA
2/6/14 <0.01, T=10
8/13 <0.1 (ADT2, post-RT)
3/13 5.2 12% PCA3=31
9/12 4.1 15%
Post Edited (Redwing57) : 3/11/2014 11:40:07 AM (GMT-6)