Posted 2/8/2020 8:53 AM (GMT -6)
My layman opinion is that you are very unfavorable intermediate bordering on high risk. The high volume cores mean the cancer is at the capsule and maybe even out. You dx is similar to mine, I just had a higher PSA, but both show a boatload of G4. You treat the G4 and disregard the G3. Though I usually favor a read by Epstein, I am not sure it would make any meaningful difference in a treatment approach.
As to ADT, if you are going to use radiation as a an initial treatment, then you could start right after the scans. If you are going to have surgery and then probably salvage or adjuvant radiation, then you would start ADT after the surgery. Rarely does one have ADT before surgery as it changes the prostatic tissue and make difficult surgery even more so. If the scans show Mets, then it means systemic treatment and possibility debulking of the source, often by using radiation to lessen side effects.
Your next meeting will give you the information to decide on a treatment direction and sequence.