East Idaho Guy - Thanks for additional info, it appears that you had your MRI after your first standard 12 core biopsy which was followed by a second 15 core biopsy which sounds like a MRI guided biopsy given the extra cores, correct? Either way it seems that there is something there that may be causing the PSA rise.
Given your rapid rise in PSA to more exciting levels and an apparent identifiable PiRAD 5 lesion, it definitely would be worthwhile to have a second opinion on the latest biopsy pathology. To save you some time if you haven't got this far, the Epstein/JHopkins link is below:http://pathology.jhu.edu/department/services/secondopinion.cfm
Make sure the people who have your pathology samples have this website info as it supplies all the necessary info. You may also want your URO to check for a possible prostate infection since that can cause PSA rise coincidental with a PCa diagnosis from what I have read in some cases, just a thought.
In my experience, the month after your PCa diagnosis is a rough time and your mind goes into hyperdrive thinking about
everything imaginable and sleep is terrible. This site can help a lot with the process of landing back on earth and focusing future efforts. You do have time based on what you know already and you probably have all options available to you so just take it slow. I only know what I know about
PCa from my limited experience to date but the collective wisdom of the group here is pretty remarkable and helpful. You just have to sort it all out at the end.
As a side note, I think the Huntsman Cancer Institute in Salt Lake City at the University of Utah has a decent reputation and should not be too far from you. After that, you can head to the West coast, Mayo, Houston, Cleveland or the East Coast for the well noted cancer institutions but I suspect that your PCa is simple enough at this point to be treated at any competent cancer center once all the data is in. Others may disagree and recommend only the top three centers which is hard to argue with but you have to live your life also so once you know what direction you are going to go, then search out the most appropriate
location for that service. Just my thoughts on a rainy Sunday morning. Good luck
8/2018-MRI, PI-RADS 5
8/2018-MRI Biopsy, 4+3
11/6/18-RALP @ St. Johns
11/2018-Post-Op Path G7 (4+3) 5% Tert Gr 5, pT3a pN0 Grade 3
Pos. Marg (SM+), EPE, <3mm, L=0.1mm?
11/2018-Decipher 0.47, Ave. Risk, 4.3%/4.8%
“Difficult to distinguish EPE vs intraprostatic incision, 3mm” Extent:pT2x