44yr PSA180 Gleason9 non-metastatic. Surgery or Treatment?

You are awfully young to have prostate cancer. I wonder if it’s due to things that are related to the military and The places you have been.

You really need to get a Hereditary genetic test. People who get prostate cancer that young almost always have a genetic issue. I got it at 62 because I have BRCA2. My brother got it at 75 because he doesn’t. My father died from prostate cancer so it makes a chance of my brother and I having it almost double. I had Two aunts get breast cancer. One of them died, and Her daughter died of breast cancer at 60. All must have had BRCA2, But it happens quite a long time ago, so it wasn’t available then. My mother gave me BRCA2.

You have a very high chance of having BRCA2, Because of the breast cancer and prostate cancer in your family.

Have you had a PSMA PET scan? The CT scan is old Technology, The PSMA pet scan is the standard for finding prostate cancer these days. You should tell your doctor that you want a PSMA PET scan before you make a final decision.

Once you have that hereditary genetic test And find out whether or not you have BRCA2, You can make a much more educated decision. If you do have BRCA2, then having a prostatectomy makes a lot more sense, As long as the cancer has not spread beyond the prostate. Something you can’t really find out without that pet scan.

The reason I say a prostatectomy makes more sense is because Of how prostate cancer has reoccurred because I have BRCA2. I had surgery and 3 1/2 years later than the cancer came back. I then had salvage radiation and it was 2 1/2 years later that the cancer came back. I had 2 more reoccurrences but It’s now 15 years since I had surgery, I was a Gleason seven which gives me a better chance of progression free survival. I have been on ADT for nine years and an ARSI for six.

Medicine is moving quickly to help with prostate cancer patients. With proper treatment, you could live decades because of these new developments that keep coming out. Be proactive and get the testing I mentioned done.

I’m sure your doctor will agree that these are the best things you should do before making the decision.

Hi Jeff, thanks for the prompt reply.
I have not had the PSMA PET scan. However the biopsy confirmed 9 out of 12 samples with gleason 9 level cells.
I have not had the BRCA2 test.
This is all new territory for me and a rollercoaster for me right now as 10 days ago I just walked in to get a routine prostate check, and now my world is upside down. But I guess, you guys all went through this stuff.
Anyhow, thanks again for the info. I will look into it.

I would think a Gleason 9 qualifies you for a PMSA. The information in that scan is super valuable at all stages including pre-treatment. Ask for it!

Welcome to the club no one wants to join. This forum is amazing and the support is fantastic. All the advice here so far is spot on and go get the PSMA to rule out spread, ASAP. Like you my family history of cancer is high. Once you get the PSMA back you will know more about treatment and options. I opted for a RARP based on my family history and my Urologist and Surgeon recommendations. If you get Radiation/chemo first it can mess with your Colon Kidneys and Rectum. All of us here have had "our journey" Prostate Cancer is scary and confusing etc. You are very young to be diagnosed. I'm one of the younger old duffers here at 60. Ask this forum as many questions as you want, we are all here to support you and let you know that you are not alone in this.

get immdediate PET scan..if all negative, two options..prostate removal ( since most of your prostate is malignant ) or option 2 is EBRT therapy to destroy cancer in prostate...Germany has fine doctors and technology..you have time to consider the options..but get the pET scan scheduled..ASAP..that will be the defining event...good luck, you are gonna live many more years I think..but you will need to be monitored for the rest of your life ( PSA test twice yearly..watch for spikes)

Thanks all for the support and the suggestions. I will contact my urologist again on Monday.
I would say that the best part about living in Germany, at least in this case is the cost of Healthcare. Almost everything is covered as long as it is prescribed by the doctor.
I will follow up with you guys on Monday.
Also, as soon as the biopsy results came out, the urologist put me on Bicalutamid 50mg 1 per day. He said that this will stop any grow.

University Hospital-Griefswald, LMU University Hospital- Munich, are several highly recommneded hospitals in Germany..you have time to explore which you prefer but I would say you need to be under care by mid October with a good oncology team

As has already been mentioned, get the following asap:
- PSMA
- Genetic test
- Decipher

This will give you important additional information as you see other doctors.

Does your Biopsy report mention cribriforms or intraductal?

Being in Germany, also look at the Martini Klinik in Hamburg (belongs to the university of Hamburg) and the Klinik für Urologie in Gronau (NRW). Germany has some of the very best specialists for PCa. Unfortunately, there are also some private clinics peddling unproven treatments, stay clear of those.