What imaging studies you had and what contrast agent was used?

@jeffmarc In the USA do Urologists request a PSMA -PET Scan for Gleason 6 or more importantly " Favourable Gleason 3 + 4 = 7 . Here in Canada it's like pulling teeth , even when the patient offers to pay privately ? I feel Canada is way behind in requesting BRAC1 & 2 Tests . plus PSMA - PET CT Scans even though there are many locations performing it .
I am on Active Surveillance with Gleason 6 in 4 Cores and 3 + 4 = 7 in 2 Cores . I have tried 3 Urologists for these referrals - NO LUCK THUS FAR .
I understand if you have the BRCA2 Gene there is a higher risk of spread and metastasis.

What a urologist will do varies considerably. Some will offer a PSMA pet for 3+3 or 3+4. In your case, I’m pretty sure the insurance companies would have no problem paying for that test. In Canada, there’s a completely different medical system.

As for BRCA testing, and genetic testing for other anomalies, this has been highly recommended for all doctors to do. Places like UCSF and Mayo (And many others) Have their patients checked almost all the time. If there is a history of cancer in the family, then those tests are almost always done. If there is no cancer in the family, then many doctors will not think genetic testing was necessary. Fortunately, in the US if you’ve got prostate cancer, you can get a test for free from prostatecancerpromise.org

So my dear case, do you have cancer in your family? Both of my mother sisters got breast cancer. One of them died as did her daughter from breast cancer. My grandfather died from pancreatic cancer. Having those multiple cancers made it obvious that I needed to be tested, But it wasn’t done until 11 years after I was diagnosed with prostate cancer. Things are changing, but it’s slow moving.

Thanks everybody for extra information and discussion about this topic. We were never offered any PET CT before this latest biopsy where 4+3 was discovered in one biopsy core. My husband had only PSMA MRI as part of surveillance and only one biopsy in 10 years of surveillance. IMHO once gleason is discovered transperineal biopsy should be offered to patient every 2-3 years since 3+3 can progress to 4+3 with ductal involvement without much change of PSA . That is what happened to my husband. If we had a chance to discover 3+4 we would have insisted on doing treatment at that point and not wait any longer. At this point we got referral to do PSMA PET CT but I found information (by reading tons of papers) that it is good idea to have PSMA PET MRI also since the first one scans whole body including bones and PSMA PET MRI is more specific for soft tissue and tissues and organs surrounding prostate which PSMA PET CT might miss.
Please if anybody has different information correct me - I am still learning and I am overwhelmed at this point.
Facilities that offer PSMA PET MRI are not available everywhere though, it is for some reason rare to have that option. Luckily we have one center in SF and we are now trying to get referral for that too. For many patients with very early stages and non ductal involvement it might not be so important but since my husband has one plug with ductal involvement I think it would be extremely helpful to have one. So little research done about IDC since it is rare entity *ughhhhh Like it is not enough that we have 4+3 but it had to be something extra possibly dangerous and obscure on top of that and with little info and not many specific options for his case at the same time (!?). It sucks big time...

@jeffmarc My father was from a family of 10 . Nine died from various forms of cancer -- Except my dad , who at age 78 took a stroke from diabetes . He passed at age 84 from later said complications - Sepsis . My sister passed at age 50 from breast cancer .
Being from Ireland originally , and my father being from this large family , my associates and friends assume I am Catholic , which I am not .
My response : My grandparents . " Were horny ".
Cheers , Enjoy your day .

Have you been through the NCCN Clinical Guidelines documentation (not their Patient Guidelines)
including the footnotes for each relevant section you read? If not, you'll find it very helpful as it addresses each step of diagnosis, risk assessment, imaging, treatment and recurrance.

Can you schedule meeting with a doctor at UCFS to ask, what imaging is best for your husband given his most recent recent biopsy pathology and the various treatment options? The imaging recommendation could vary depending on whether you are thinking of focal therapy vs surgery vs radiation.

Thanks so much for info about NCCN cl. guidelines, I will google it ASAP. We have zoom meeting at the end of April with USCF doctor , that was the soonest available option. My husband contacted department yesterday pleading for some guidelines regarding imaging since we wish to have everything ready for that zoom call. Lady said that she will try to find that information for us and will call us back. If nobody calls today, we will call again. In the meantime we succeeded to per-sway present urologist to send sample for Decipher testing *sigh. My husband asked for that day of the biopsy and he did not send it. So now finally it is sent and they said 2 weeks waiting time for results. Fingers crossed it will come as low risk and I will be able to "exhale" , at least for a day or two. Regarding treatment - we will do whatever is suggested, we are open to anything that might help. Regarding incontinence or ED I personally would have my husband in Depends and alive and just cuddle with him for the rest of my life with zero complaint. Honestly, even if some evil fairy told me that I have choice of him being well and alive and happy but with caveat of me never being able to see him again and live alone, I would choose that in a second. So , we really would do whatever will give the best result no matter what.

In case you haven't seen this study: https://www.redjournal.org/article/S0360-3016(24)02058-3/fulltext

Thanks from the bottom of my heart - I did not see it. < 3

Our top choice was always RP even when he was "low grade" but we were told that it was unnecessary and nobody does that since it is such low risk and that "issue" most probably will ever progress . Well, it does not progress until it does : ((( and for some of us in a pretty bad way.

Once more - thank you for all of your help and support < 3 It is greatly appreciated and always helps me see a ray of sunshine in these hazy and murky days.

Is your messaging working on MCC now? If so, I sent a link for this afternoon's Promise Annual Webinar. It's live and will have an opportunity for Q&A.

Just found it !!! I wrote you back - thankfully "reply" works , I will have to check if I also can "initiate" PMs , I hope my "new member" limitations are over *sigh