Things I've learned from my cancer journey...

How to move from acceptance to action...

First, get through the shock and denial, you're entitled

Then bewilderment - you've talked with your medical team and trying to figure out whether to simply accept early advice and leave their care in the hands of the medical establishment, or to become more involved in the decisions around your cancer treatment. This leads in one of two directions. Either you begins to realize how complex and rapidly advancing prostate cancer care can be and jump on the information train; or, after an initial dive into information on the internet, books, advice of friends, etc., you regress and become less involved and more passive. Hopefully you are the latter!

Then, engage and plan. Assuming you don't give up control and do decide to be a more active participant, oddly enough you may look forward to what outcome you.want to achieve.

One of my rules is: Walk in the door ready to start the conversation at a different level. I don’t have to spend time talking about the basics, things like Gleason grade, group and clinical stage, PSADT, PSAV, doublet and triplet therapy, NCCN guidelines... and what they mean. I already know. I can have an intelligent discussion about the merits of a particularly treatment for my cancer, my likelihood of being cured, and risk of side effects

Speaking of NCCN Guidelines, grab your favorite drink, mine's a Manhattan or Old Fashioned and start reading them - https://www.nccn.org/guidelines/patients. The NCCN Guidelines for Prostate Cancer include recommendations for staging and risk assessment after a prostate cancer diagnosis and for the care of patients with localized, regional, recurrent, and metastatic disease. They are a starting point for discussions with your medical team.

With the clinical data you describe - Biopsy score was Gleason 8 (4+4), Grade 4. 12 of 16 cores involved. Cribiform pattern present, Extraprostatic extension and Perineural Invasion along with that increase in PSA, Doublet or triplet therapy may be something to discuss with your medical team, here's one link to start, you can find others - https://dailynews.ascopubs.org/do/would-you-use-doublet-therapy-and-not-triplet-therapy-patient-newly-diagnosed-mhspc

Surgery may not be the best option given your clinical data. Discussions with the radiation oncologist and medical oncologist should give you other options. One thing to consider, mono-therapy such as your urologist is describing, is not your friend.

The PSMA imaging may give you the final piece of clinical data to inform your discussions and decisions with your medical team. Another piece may be the PSDAT and PSAV (https://www.mskcc.org/nomograms/prostate/psa_doubling_time) though with what you describe, 2.8 to 15...in six months, something aggressive is going on!

I've attached my clinical history, aggressive, not as aggressive as yours may be though. An aggressive PCa generally requires an aggressive approach to treatment, here I am, 10+ years later.

Be sure to post back with your PSMA imaging results and what your medical team recommends!

Kevin