Posted 7/19/2021 3:58 AM (GMT -6)
Hi Gshoe and boyfriend, and welcome to the greatest club you probably never heard of before, and most certainly never wanted to join! I myself am a relatively new member, having only been diagnosed (dx) in April 2021 (feels like forever ago!). I am sure you both feel like you are being blasted by a fire hose of information. Allow me to reinforce and expand on the comments of others.
1) DON'T PANIC - and don't rush into any treatment - Prostate Cancer (PCa) is almost always very slow growing, and you can safely take weeks, even months, to learn about yourselves, your cancer, your treatment options (depending on your insurance, location, and means and ability to travel). This is time wisely spent that will probably have no impact on the chance of cure or long term outcome, but your learning will almost certainly greatly improve your satisfaction of treatment outcome.
2) Gather information about your cancer - your boyfriend's biopsy (bx) will show the kind and amount of cancer cells they found in the prostate. Gleason Score (GS) and Gleason Grade (GG) are short cut summaries, but they are based on subjective observations of the cells through a microscope. Getting a second opinion on the bx slides (e.g. from Dr. Epstein and Johns Hopkins) is about $300 (may be covered by your insurance) and well worth the added confidence in your treatment needs. There is also the location of your cancer, is it only in the prostate (localized) or is it starting to spread - Extra-prostatic extension (EPE), Seminal Vesicle Invasion (SVI), Perineural Invasion (PNI), or has it gone far and wide Metastasis or Mets. Some of these can be found in the bx, but more information can be gathered with CT scans, MRIs, bone scans and other more advanced scans.
3) Seek out other (kinds of) doctors. Your boyfriend was probably diagnosed by a Urologist. Most urologists are surgeons - they know how to cure by cutting (Radical Prostatectomy - RP), but that is not the only way to cure PCa. There are many forms of Radiation Therapy (RT) - Internal radiation such as High Dose Rate Brachytherapy (HDR-BT), Low Dose Rate Brachytherapy (LDR-BT aka 'seeds'), External radiation - (there are a whole slew of abbreviations here, IMRT, EBRT, SBRT, ...) using X-rays (photons) or Protons, and with different trade-offs for number of treatments vs dose per treatment. (E.g. Cyberknife or SBRT is simply a short course, maybe 5 treatments, of very high dose per treatment of the same kind of external radiation as 'ordinary' radiation treatment). Because there are these different kinds of RT some doctors and clinics specialize in one or another. You may need to see more than one Radiation Oncologist (RO) to learn about which RT would be best for your boyfriend.
Also a Medical Oncologist (MO) can treat your boyfriend's PCa with drugs, depending on the stage. An initial short course of Androgen Deprivation Therapy (ADT) can 'stun' the PCa, shrink the prostate, and give you even more confidence in taking your time in making the right treatment decisions. And if your PCa has spread well beyond the prostate, then removing the prostate may be unhelpful, since that will not remove the cancer. Instead the MO will treat with systemic drugs.
4. ALL treatment options have side effects (SE). Some are permanent (semen loss from RP), some are probably temporary (but may be permanent), some folks don't get them at all. Some start severely and improve with time and therapy, others develop over time and get worse. SE are of mostly 3 systems - Sexual (loss of Semen production, loss of erections, loss of desire), Urinary (incontinence, difficulty urinating, burning), and Rectal (diarrhea, constipation, blood). Part of your decision process is figuring out which set of side effects you and your boyfriend find least objectionable.
One thing I have found is that the people who are most dissatisfied with their outcomes (particularly long-term SE) are not those with the worst SE, but those who did not explore their treatment options. Learn about your choices and you will know that you did right by yourselves!
5) Finally, bring back all your detailed information here and ask all the questions you can. The folks here are Great! and love to help you find the right path for you and your boyfriend. Every man's journey is unique, but we are all here together! The only one who knows what is right for you is you, but we are all here to help you figure that out. Also, learn how to make a signature with a synopsis of your PCa dx and treatments - it will keep you from having to repeat yourself as you live this lifelong journey here.