Being treated for Gleason 9

I am 67, with PAS 12 for over 6 months, and last week urologist called me from Cancer Hospital to tell me about my prostate biopsy report. I have been diagnosed with 5 G7 and 4 G9 out of 12 samples. Its and aggressive cancer. he talked about the 2 available options one is surgical removal and the second one is radiotherapy, he explained the P and Cs of both treatments. Next step is CT. Scan for bone. No PET Scan or MRI is discussed at the moment. Waiting for my appointment with CT Scan clinic. I have been watching videos on Cancer Hospital YT channels, Patients survivors and of some surgeons. So many different opinions and recommendations making me confused. What are your thoughts on my situation with G7 & G9.

@khabib
You are a Gleason nine the sevens don’t matter. That is very aggressive prostate cancer.

You need to get a PSMA PET scan. A CT scan is a total waste of time, your urologist does not sound well informed about how prostate cancer diagnosis is done today.

The PSMA PET scan can tell whether or not the cancer has spread to other spots of the body. The CT scan cannot really do that properly. The Standard of Care is not a CT scan it is a PSMA pet scan.

If your cancer has spread outside the prostate, then you need to consider radiation instead of surgery.

While you are working with a urologist, you really need to move to a Genito Urinary Oncologist. They specialize in prostate cancer and would never have you take a CT scan with your condition.

If you mention where you live someone here can probably tell you about a good GU oncologist for you to go to.

If you can go to Mayo Clinic in Rochester, get an appointment with Dr. Heath she is a superb GU Oncologist for treating prostate cancer. You will get better treatment than your urologist seems to be heading toward.

@jeffmarc Thanks you so much. I live in northern Manitoba Canada, the nearest Cancer hospital is 800KM in Winnipeg. According to the urologist my biopsy report has been forwarded to an oncologist, but in the meantime, a bone CT scan has been requested at our general hospital. I told the urologist that I already have done 2 CT scans in 2025 for Diverticulitis, so another CT would be too much, but he said this is needed to look for any bone penetration of cancer cells. Now I am getting worried about it. Thanks for your well explained reply.

I am also 75. I am a Gleason 9 confined to the prostate. The term "aggressive" is vague and frightening. I have been very happy with the treatment decisions made by my team at Moffit Cancer center. I had 6 months ADT, Brachytherapy and SBRT.

@khabib just out of curiosity where is the nearest PET scan located, do they have it locally?

@khabib
A bone scan is not the same as a CT scan. Two different machines quite different treatments. I’ve had both in the last six months because my PSA is too low for a PSMA PET scan to find anything.

If you aren’t on ADT and your PSA is above one then it makes sense to do a PSMA PET scan.

@khabib After a spike in my PSA, I had an MRI scan which showed a possible lesion in my prostate. I quickly had a biopsy which showed two Gleason 9 samples, a couple of 7s and the rest benign. Following the biopsy, I had a PSMA scan which discovered two small lesions in lymph nodes adjacent to the prostate. I also had a bone scan which showed no evidence of the prostate cancer anywhere else. I was 79 at the time and met with two radiation oncologists, one of whom recommended 28 sessions of radiation and a year of ADT, all done locally. The other RO recommend 5 SBRT sessions and 4-5 months of ADT. I chose the SBRT even though I had to travel a good distance for the 10 day teatment and a month out my only inconvenience is caused by the ADT (Orgovyx) which can have side effects. Mine are very manageable. Overall, I'm very pleased with the path that I took.

Biopsy in July 2024 showed G7 at age 66. Chose surgery in November 2024 and was "upgraded" to G9 with some adverse factors, including bladder neck invasion, cribriform and a few others. Aggressive. PSA remained low (0.04) but trending up so we decided to move ahead with radiation. Lupron shot in October 2025 and radiation started 12/1/25. I've completed 13 sessions with 26 to go. I was confident that surgery would get most of it; now I'm now 68 and hoping the radiation does the job. I'm less optimistic now than I was then. Counting on turning the corner in 2026.

@khabib It sounds like you need to take control of your treatment. Some doctors will prescribe procedures meeting their needs not yours. If a CT is the only technology your doctor has access to, then I would find another Doctor even if you have to drive a long way for it. At this point I would be asking your doctor why a CT and not a PSMA ,which is a standard of care, at least in the US. Compliant old men accepting whatever is offered is a thing. Doctors offices are full of them. Advocate for yourself. Ask why as many times as needed until you get answers. I would suggest picking up the phone and finding a more sophisticated practitioner. If you can find a GU that would be great but a teaching or national hospital would also meet your needs if possible. We are in different countries and they operate differently.
I suspect my diagnosis process is very similar to others on the forum.
My diagnostic process follows from 3.5 years ago:
PSA 3-increased 1 point in 2 years which got my Dr. attention.
DRE Positive for nodule
4K Blood score-positive (PSE test is the most current I believe)
MRI-positive-result local
Fusion Biopsy-G9 Grade 5 (MRI/CT overlay for accurate targeting)
PSMA Pet for spread-Negative
RP surgery
BCR two years later .224
PSMA-Negative
Only then a CT scan for my radiation tats.
25 Session EBRT/with 3 months lupron followed by 3 months Orgovyx.
2 months post Tx. T-230, PSA undetectable. 6 Month in 3 weeks.
Best wishes, Merry Christmas and may you receive the best care possible with the best possible outcome for your new year.

@chippydoo Thanks you so much for you advice and detailed information. Yesterday I received call for CT on Tuesday. I am traveling out of country on January 7, for full 4 weeks, as all travel with family was booked 2 months ago, before biopsy. Now I had no choice to cancel this scan and wait for another call in weeks from Cancer Clinic to discuss other options like PSMA. Thanks you for your reply. Merry Xmas and Happy new year