I'm confused by what you said about
they'll tell you a TURP is middle ages, and you shouldn't even get one
Who suggested a TURP and why? Has there been evidence of urinary tract obstruction? If so, that fully explains your high PSA. Have you had a cystoscopy?
At your relatively high PSA, you shouldn't require a PET scan to detect any distant mets -- a bone scan/CT should do just fine. If that is clear, and a cysto shows no obstruction, and the prostate biopsy didn't say anything like "evidence of chronic or acute inflammation," and your Uro is convinced that you didn't get a prostate infection from your last biopsy (antibiotics do not
rule out prostatitis), I can't explain why it your PSA is so high, but I agree with John T that you may want to rule out benign causes first. As I understand what you wrote, you had just one core of GS 3+4 and 90% of that was pattern 3, only 10% was pattern 4. That small amount of pattern 4 cancer just should not be putting out that much PSA.
With a negative DRE and so little cancer, there's little chance of ECE that might preclude surgery. And if there's no evidence of enlarged LNs are distant mets, there's nothing that precludes radiation (or focal therapy). If you do have a urinary stricture (discovered with a cysto), radiation or focal therapy may make it worse, surgery may make it better.
The decision on which treatment for PC you want is based on your diagnosis. As an intermediate risk patient, all common therapies have a good chance (about
the same) of curing you. So the decision becomes about
SEs and other psychological factors. Here's a list of questions to ask yourself:
• Do I need to see a pathology report to tell me how contained it was?
• If I choose radiation, can I live with the fact that PSA goes down over a number of years, with bounces along the way, and never becomes undetectable?
• If the pathology is adverse and PSA does not become undetectable, am I prepared to undergo adjuvant radiation with all the potential side effects that entails? (Your doctor has hopefully run a nomogram showing the probability of this happening)
• If the radiation doesn't work, am I prepared to have a biopsy and possible focal brachy re-treatment?
• Which bothers me more - the potential for incontinence and ED after surgery or the potential for retention and irritative effects after radiation? (given the probabilities of those side effects)
• Do I understand the other possible side effects of surgery? (e.g., infection, hernia, climacturia, penile shrinkage, stress incontinence, etc.) Am I prepared to take on penile rehab?
• Do I understand the other possible side effects of radiation? (e.g., fatigue, proctitis, hemorrhoids, frequency, urgency, burning while peeing, ED).
• Am I prepared to undergo the time and SEs of radiation?
• Am I prepared to undergo surgery and its recovery?
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results
•SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA
•PSA now: 0.2
No lasting urinary, rectal or sexual side effects