New and Need Guidance: What questions to ask about prostate cancer?

@vulcan, I'd like to add my welcome. I agree with the others who have posted helpful replies. You are asking all the right questions. As you search for information and experiences about prostate biopsies, you may appreciate these related discussions:
- Is a biopsy only way to diagnose prostate cancer? https://connect.mayoclinic.org/discussion/is-a-biopsy-only-way-to-diagnose-prostate-cancer/
– Anyone have an Ultrasound-Guided Transperineal Prostate Biopsy?: https://connect.mayoclinic.org/discussion/anyone-have-an-ultrasound-guided-transperineal-prostate-biopsy/
– Prostate transrectal biopsy https://connect.mayoclinic.org/discussion/prostate-transrectal-biopsy/

Have you considered getting a second opinion from a cancer center?

You don't mention if you are spirtual or Christian or what ever , thats not anyone elses buisness. Please do nt take my words as offesive or being any thing les than encouraging. Pray and continue to pray ! for your Father, his Drs. and the people who will be careing for and treating him
I was recently diagnosed, and have opted for removal surgery. the moment I was given my psa the latest one in late 2022 was 32, sleep became very difficult and didn't seem to be restful. Prayer changed that for me. Yea the upcoming surgery is a stress , but God is BIGGER and by far MUCH more powerful. He will bring me thru this. Amen

Dear Vulcan, you and your father are in the same situation that all of us were at some point. I was diagnosed in 2018 with PCa with a Gleason score of 4+4 after a traditional biopsy with no MRI. My Urologist gave me Dr Walsh's book to read before I made my decision on treatment. The most important information I got from the book was that the success rate for treatment was much better at a Cancer treatment center. They are much more on top of recent research, which is advancing rapidly, and more likely to have the most advanced equipment, which is also advancing rapidly.
Since each form of treatment comes with its own specialist, you may get different advice from different specialists.
I made my decision to use proton beam therapy based on talking to individuals who had tried different therapies, which I don't recommend. I would've much preferred a doctors help but my GP couldn't even advise me.

My decision was based on the potential of damage to my body based on the different treatments at that time. Things have changed, so do your own research. I had 20 doses of radiation, but they are now doing 5 treatments in many cases.
I just had my 4 year checkup and PSA was .1. Since I still have a prostrate, it can still generate PSA. If it gets above 2.0, they'll look for cancer. The only other thing that generates PSA is the cancer. If you have surgery, any increase in PSA will be from cancer. I'm 78 and age does come into play regarding treatment. The younger you are, surgery may be better and the older radiation.
This is likely to be a stressful time. It was for me. The more I learned and made my decision, the less stressful. My life now is full and I have no regrets.
The best to your father!

The most important thing I can tell you is to make sure your doctor is up to date on current treatment. My Urologist wanted to go right to biopsy even though my psa went from 4.1 to 3. All my tests were borderline and the DRE showed nothing. She told me the MRI was too expensive and no insurance would pay for it. MRI cost $950 biopsy $20k.
Every test I get I toughly research the results online. On most things she was wrong about 50% of the time. There are also some good seminars on youtube. I have spent 100's of hours researching my disease and learned many things the medical industry just avoids. After 6 months of Lupron therapy I was barely functional. Reading on a number of sites I found out most people have low testorone after therapy. After TRT I almost feel normal. and my PSA is 1. Because of an experiment in the 60's where one of three people got worse on TRT the phrase Testorone is like pouring gasoline on prostate cancer.

It’s a relief to have someone post that they have had no complications with pain or incontinence. I just got my biopsy results back last week - 6 Gleason - am 61 with no other health issues and considering the RALP option. Your post was very encouraging. Thank you

At what point of the process did you have a PSMA scan? Before or after biopsy?

How did you get in contact with an oncologist? As of right now we are only speaking with a urologist. I'm assuming you spoke with an oncologist only after a biopsy and when you were planning treatment options?

Were you told exactly why surgery after radiation was worse than pre radiation?

Very happy to hear you are doing good right now

Do we need to ask for them to test for aggressiveness before they run the biopsy in order for them to get an additional sample, or can they test for it with just the normal samples they extract?

They take the biopsy material and send it off to the company that runs the test such as the decipher test. About 2 weeks later the urologist gets the report. You can get the report yourself if you fill out a form with the company to do so or ask the Dr.

You are welcome. Good Luck. Glad to hear you are at a Gleason 6. I was a 7 (4 + 3). 2 biopsy cores came back 6 and 2 came back 7 for me. I had to take action. A Gleason 6 is good that cancer is very early stage and your chance of full recovery with no BCR is excellent. It's bad in the sense as now you have 1 more option which is waiting and watching. If you choose to watch make sure you are getting PSA checked every 3 months at least (I'm sure your Urologist has discussed this with you already).

I had the Biopsy prior to the PSMA scan, the PSMA scan showed my cancer was confined within the gland and had not invaded any of the surrounding tissues. Based on that, my Urologist wanted me to have a Lupron shot, as Hormone Therapy, to reduce testosterone production. Testosterone feeds the growth of the cancer. Ergo, the cancer should not grow or spread due to the Lupron. The Lupron DID give me hot flashes, several times each day and night. The Venlafaxine that I mentioned did provide relief.

When my Urologist told me that I had cancer, we briefly discussed the options, radiation and surgery. In that visit he gave me name and phone numbers of a Radiation Oncologist and of a Surgeon/Urologist. This was after the biopsy.

By the way, my wife was accompanying me to all of these visits, and the doctors were kind enough to allow me to record the conversations on my phone. (The later versions of Microsoft Word have a "Dictate" feature from the menu. So, in Word, I clicked the Dictate button, then started playing the voice recording, and, if the voices are clear, you have a Word document of the conversation, a document that needs editing as it is all run together and you need to insert headings here and there to identify the speaker, for readability's sake.)

After the Radiation Oncologist visit, I was leaning towards radiation treatment.

I spoke with the surgeon, whom my Urologist had worked with. In this discussion, he stated: "And so, from a cancer standpoint, the survival benefit in your case is pretty similar between surgery and radiation, I would say. The main difference is if you have a recurrence from that with radiation your treatment options are much more limited as opposed to surgery. With a recurrence after surgery, you can get radiation afterwards. Then, otherwise, if you're going to live a very long time you worry about secondary cancers with radiation as leukemias and lymphomas. But those are rare."

After the surgery, i had some discomfort, which is what a call "Pain rating less than 1." I had some pain pills from my Urologist but did not use any.