Good morning. I wanted to add my experience and suggestions as I was diagnosed with G8 at age 68 3 years ago.

G8-10 are considered high grade, aggressive cancers. Men with G6 and some G7 cancers have many months (or longer) to research and make decisions about treatment options. Although your husband's cancer treatment is not an emergency, you should proceed as quickly as possible and decide on a treatment option. I am not suggesting you need to do something in the next few weeks but just move the process along.

In my opinion, it is critical to have a consultation with not only a urologist but a Radiation Oncologist as well. Your husband really has 2 options: surgery (radical prostatectomy or RP) or radiation therapy treatment. You may also want to seek the opinion of a medical oncologist but need to pick one that specializes in genitourinary oncology (kidneys, bladder and prostate). The field of prostate cancer is evolving so rapidly that it is very difficult for a general oncologist to keep up with treatment of all types of cancers.

From my extensive discussions and research about treatment options for G8, radiation and surgery have about equal long term survival rates. You will hear/read people advocating for one or the other; usually people that have had that particular treatment and therefore believe it is best, or those that have had side effects or complications and wish that had had an alternative treatment. Individual stories are of no benefit to you or your husband. It is the large numbers and clinical trials that should guide you.

Your doctors may want your husband to have a PSMA PET scan. This is a relatively new test that has the best chance of identifying any spread outside the prostate. There are different treatment options if: 1) the cancer is confined to the prostate (surgery is a good option), 2) if the cancer has spread outside the prostate but remains localized within the pelvis, 3) if the cancer has spread/metastasized outside the pelvis (usually to bones or lymph nodes). If the cancer has spread outside the pelvis it further divided onto high volume disease and oligo metastatic disease. Most progressive, knowledgeable medical oncologists treat these two differently.

Seek second opinions. Start making the appointments now because it may take weeks/months for him to be seen in a busy practice. Go to a Center of Excellence, even if it means you need to travel. I travelled from Georgia to Johns Hopkins in Baltimore and it may have saved my life. Your husband needs treatment by an expert with both cutting edge knowledge and experience.

Surgery has side effects. It can result in incontinence (usually, but not always, temporary) and erectile dysfunction. These side effects depend on age, extent of disease, skill of the surgeon and your husband's presurgical condition. Radiation also has side effects; some are more acute but some are delayed. The Radiation Oncologist can explain these in detail.

Be careful what you read. Much is out of date. The survival from even aggressive prostate cancer has changed significantly with a myriad of treatment options over the past couple of years. More are on the way.

Good luck to both of you.