How much time should I expect to be able to plan treatment?

For a second opinion biopsy, I would definitely go with

Dr. Jonathan Epstein biopsy
https://advanceduropathology.com
You can call him ahead of time and talk to him about it. After the biopsy, he will talk to you at length about what he found, Much better than what your doctor is doing.
‘
Dr. Zhou it’s also good, but I don’t think he is as available to speak to.

What I would do is obtain your recommendations for surgical and radiation oncologists and begin your research into treatment protocols and into additional surgeons if you want certain type of surgery, These appointments with the surgeon and radiation oncologist usually take time to get set up especially if they are well known and in high demand.

Just to add, I obtained two surgical consultation’s and two radiation consultation’s. These took time to set up as they were in demand and I actually decided and went with my second surgical consultation which had been my fourth appointment over a 7 week period. Even then his surgical calendar was out another 4 to 6 weeks. All of these things take time and that is why they have established time to treatment so allow yourself some feelings of relief if you believe gosh I have cancer it must get treated right now or it is three months since I was diagnosed and I still have not been treated

Unless you have started ADT my answer is: How much time do you want to give your aggressive prostate cancer to metastasize? If you were unfavorable intermediate (4+3) I would agree with 6 months or even more not making much difference. If your disease had already metastasized the same. However, you will be much worse off if it does spread before treatment. The probability may not be high, but do you want to take that chance? In any case it will probably take at least 3 months to get surgery or start radiation.
ADT will freeze development and provide more time to decide. It will certainly be prescribed with radiation and there is a good probability with surgery at 4+5. Also, a high probability (due to 4+5) of requiring salvage radiation due to micro metastasis in the local prostate area showing up after surgery either in a few months or years.

@jim18 I agree with you, Jim. Even if surgery is chosen, studies have shown success using ADT pre-surgery to shrink the gland and sharpen the anatomy.
Despite its much feared reputation, ADT is a miracle drug when it comes to PCa. Best,
Phil

They’ve looked at this as it relates to surgery —> This study from 2020 reported in JAMA indicates that even with localized, high-risk prostate cancer, a surgery delay of up to 6 months has no statistically significant chance of worse outcome. —> https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773817

You can also do things simultaneously —> schedule a second opinion on your tissue biopsy, while you’re planning for treatments (whatever the 2nd opinion is). Have two plans ready to go! (That’s what I did.)

...You can get Orgovyx (relugolix) to put the brakes on the very slow process to review the options. One medical oncologist commented that the original aggressivity/prognostic value of the metastatic RISK to the Gleason scoring has been somewhat downgraded with the advent of negative results for extra-prostatic spread on MRIs and PSMA PET CT scans.

Biopsy slides:
1) 2nd opinion usually covered by insurance Mayo or Johns Hopkins offers that service too.
2) ARTERRA: AI read with comparison to thousands of others with a same G-score:
Low-Intermediate: High RISK
3) DECIPHER: genomic test for RISK of metastatic disease: Low-intermediate-high

MRI 2nd look:
AI: MRI DeepViewImaging.com
DiverJer asked a relevant question how many cores?
Your Age is an important consideration

if you had only ONE core positive, age 78, Low Risk on both DECIPHER and ARTERRA, negative for metastasis on MRI and PSMA PET Scans then you might be candidate for 6-12 months of hormone deprivation and FOCAL Brachytherapy either the temporary High Dose Rate (HDR) version or the permanent (seeds) Low Dose Rate (LDR), followed by annual MRIs and quarterly PSA tests as post treatment surveillance. By contrast multiple core positive and 65 y/o, high risk DECIPHER and ARTERRA, up estimate on 2nd MRI read....then the choices presented to you
may be different.

@pjm4416, how are you doing? Did you get a second opinion?

@jeff1963 If it helps and it probably doesn’t considering I’m in Australia but I started the process from first GP detection 21-May and have had an mri, mri results, biopsy, biopsy results, pet scan, and pet scan results now treatment discussions all in 7 weeks. All up MRI was $150, biopsy was about $2k and pet scan fully covered by Medicare.

@colleenyoung yes. It appears to be less critical than the original..haven’t met with doctor yet.