What should I do for treatment plan?

DO I need 2nd opinions from other pathologist?

If you have one Gleason 8, you are a Gleason 8. That means your cancer is pretty aggressive and you should do something about it soon. What was your PSA?

The first thing you should do is the PSMA PET scan recommended by your doctor? That will show you if your cancer has spread and you have any metastasis.

Based on what they find, you have a choice of either radiation, surgery (a prostatectomy), or a few other treatments that are available. When you find out more information, come back and tell us. Many people here will have recommendations for different types of treatments based on your results.

A lot of times when you are a Gleason eight, they want to put you on ADT right away to stop the cancer from spreading and growing. That usually means a Lupron, Eligard, or firmagon shot. You can also just take an Orgovyx pill, which does essential is the same thing. Because you are a Gleason 8 they normally want to keep you on ADT for 18 months (NCCN guidelines).

Surgery is definitely just an option at this point. If it is not spread out of the prostate, you probably can avoid surgery..

You should also get genetic testing. That will tell if you have a problem with your genetics that could make the cancer even worse over time. You can get it for free by going to. Prostatecancerpromise.org I don’t pick the option that you want your doctor involved or they won’t send you the spit tube that you mail back. In 2 to 3 weeks you’ll have results and they will have a genetic counselor discuss them with you.

Your age is also a determining factor if you should or should not have surgery.

@chunghk1
I think your doctor was doing the right thing by wanting to do a PSMA. That would greatly help him with the needed information to set up a treatment plan. So without the tests he really could not tell you what plan was, appropriate treatments, and your options.

Did he mentioned Decipher tests and bone scans?

Each individual and their cancer is unique to them. It also has a lot to do with quality of life and what you as a individual want to go through versus the pros and cons of any treatment.

I found a lot of information on PCF.ORG Prostate Cancer Foundation; free Patient Guide by download or hard copy.
And Dr Patrick Walsh MD's book Surviving Prostate Cancer.
Best wishes.

I too was Gleason 8 and had a CHEK2 genetic mutation so my care team have been treating me one level higher than they might have for my age and test results. I had the PSMA-PET scan and thankfully it showed my cancer was localized in the prostate. This scan removes all the guess work.

I did not want to do surgery. I understand the arguments in favor of it but I did not want the downsides. They put me on ADT immediately and I have now completed 28 x IMRT.

ADT is a slow, 2-year, horror story but worth it for my peace of mind that my cancer is not coming back. The IMRT was a short, 5-week, horror story but much more of a logistical challenge than a physical one. I am very happy with the result and my only issue at the moment is the painful/frequency/urgency peeing problems that began about halfway through the radiation and ramped up continuously after it ended. At this point (3 weeks after) it seems to have plateaued and I'm waiting for it to improve. It's difficult but manageable.

When I researched the treatment paths I saw that the survival outcomes were similar for all the major types and I'm personally very glad I avoided surgery. The side effects I read then and here were not for me.

Good luck making the lonely treatment decision and, whatever you choose, I hope it is effective for you.

PSA 7.4 with finasteride 5mg.
what is ADT?

my age is 72

Regret that you are joining this club, but do feel good upon entry as you now have access to a sizable portfolio of active prostate cancer treatment efforts. Long story short, the ideas shared above about education (the book by Walsh, PCF) are excellent places to get this going, as well as website of leading care centers (too many to list!).

A PSMA PET scan has a next step seems reasonable, there are other imaging tests such as MRI, Traditional PET, Bone that may provide additional insight. My insurance required that I walk from Bone to CT to MRI and then to PSMA.

72 is a great age, the middle of old age! With early detection and education, there are many options ahead of you. Just knowing that you had a biopsy, GS8 and PSA of 7.4, it is fair game to become knowledge of many paths forward. I tend to think that long-term active surveillance will not be an option, but even that is more of a perspective. If you embark on education and imaging and do a PSA test every month, you are essentially in active surveillance until you decide on a treatment option.

ADT is a form of chemical castration that results in lowering your testosterone levels to zero, the rationale being that prostate cancer cells require testosterone to survive.

Go at a reasonable pace at education, but get familiar with all the options. This will become very useful when talking with the health team.

we are here to help

Other people have answered this, but not with a reply to you.

ADT is either a shot or pills that will reduce your testosterone to below 20. It has side effects, but it usually prevent it prevents your cancer from growing and also can reduce the cancer you have. They like to do it before radiation to reduce the cancer. It also can stop metastasis from growing.

They can stop you thinking about sex, something your wife may not be pleased with.

The most common side effects are hot flashes, muscle deterioration, brain fog and fatigue. Not everybody gets all of them but usually gets one or two of them.

While on it, you need to exercise get to the gym do weightlifting, to keep your muscles from deteriorating.

It can save your life and gives you more years to live without the cancer growing.