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

Everyone on this site will respond with empathy and support and wish your father, and you well.
All of your questions are "spot on"
Many, including me, recommend Patrick Walsh MD's book " Surviving Prostate Cancer", which will provide a wealth of information and give you answers to many of your questions.
Also, the Prostate Cancer Foundation (PCF.org) has a free downloadable or hard copy of a tutorial on Prostate Cancer (PCa).
Yes, the fusion biopsy is the next best step.
IF Prostate cancer is identified, it will receive a "Gleason" score. And that will be a major factor in treatment decisions.
Treatment (tx) options exist, and there is good reason to be positive; for your father, you and your family.
A qualified, experienced Urologist and a fusion biopsy are the 1st steps.
There are recognized Centers of Excellence for PCa, as well as excellent local community resources for tx.
However, everything else is getting a bit ahead.
And, I am not medically trained.
Best wishes.

Unfortunately w/o doing a biopsy I don't believe there is any way to determine of one has PCa or not. I had a standard biopsy but was put under for it. Not sure what they do for a Fusion biopsy. I too am from Michigan and was treated by MIU. It is good your Dad is getting the biopsy so soon. I had to wait 2 months for mine. If it is PCa and hopefully its not your Dad will have multiple options with the 2 most likely being RALP surgery or Radiation. I chose the former as I was 60 when operated on with no other health issues. I had no complications from surgery to date with pain or incontinence. But as someone else replied don't get too far ahead of yourselves as there is a good chance it may not be PCa. If you want you can talk to his Urologist and ask how many RALPs he has performed just in case.

I agree with everyone that the biopsy is absolutely necessary. I had a fusion biopsy which meant they fused the images from my MRI with Ultrasound imaging to get a better overall location of prostate "hot spots" to get extra needle samples from. So I had 14 samples taken, two more than the normal number. And for sure, the Gleason score will give you an idea of how aggressive you want to be in terms of your follow up. Do your homework, talk to the best people you can, and make your choices. My decision was easier because everyone, even the radiation specialist, suggested I go with the RALP procedure. Everyone's situation is unique, so I hope your path forward is made with confidence.

There are NO “dumb questions!” Ask everything that comes to mind, write them down when they come to you so you don’t forget.

When you hear the word “Cancer,” becoming worried sick is normal and automatic. There are good stories; I went from “Cancer? Me?” to “It’s all gone? Really?” in six months during 2022.

Yes, get the book by Patrick Walsh. Read the “highlighted in gray” bits at the start of each chapter to determine whether you want to delve further into that chapter.

I had a PSMA scan, my Urologist was happy to say it was covered by insurance. This showed that my cancer was confined to the prostate gland.

I had an biopsy, revealing some (Gleason scores) of 3+3 , 3+4 and 4+3. Learn about Gleason scores.

I spoke with a Radiation Oncologist and with a surgeon to help me understand upsides and downsides to each therapy.

Read all the relevant articles you can from reputable sites such as MayoClinic,com, Cancer.org, MyClevelandClinic.org, to name a few. Print and compile into a binder is helpful.

After researching, I chose RALP from a surgeon, Dr Aaron Laviana, here in Austin TX, one my Urologist has worked with. When I informed my Urologist, Dr Trotter, in Austin TX, of my decision, he said that’s the choice he would have made in my case.

I chose surgery, as I read that radiation after surgery can be beneficial if needed, but, surgery after radiation is not a very viable option.

Weeks prior to the surgery, I spent several weeks of PT/Kegal exercises and I was fully continent after catheter removal, which was 10 days post-surgery.

My Urologist told me that the Pathology report indicated that the gland had another “node” of cancer that would have survived radiation.

Right after detection, I received a shot of Lupron, to slow/halt cancer growth. I had “hot flashes” due to that but got Venlafaxine 37.5 2x daily to control those.

When this began, in March 2022, I was 72 and had a PSA of 19.8. Now it is undectable.

Holler back with questions.

I like your questions. You're on the right track. Your dad is lucky to have your support. After the biopsy, the doctors will start constructing your dad's treatment plan. This treatment plan provides a map with many solutions for how best to help your dad—Godspeed.

Vulcan: sorry about your Dad having to go through this stuff.

Fusion Biopsy is a good choice.
Ask your doctor to test for aggressiveness using the biopsy material: https://decipherbio.com/
Nccn.org will give you guidelines as to what to expect through different phases. It was created by DR’s for DR’s and patients.
Look at viewray.com. They make the only radiation machine in existence that combines an MRI and Photon radiation machine into one operating unit. The greater the MM in radiation treatment the greater the chance of healthy tissue issues. I had 5 radiation treatments.
Get a second opinion wherever you can. I had Gleason 3+4 restricted to the prostate and a 20.2 PSA. Keep asking questions. Its a process and coming back to this web site will help you make better decisions and provide emotional support for you and your Dad.

Thank you guys for your replies. I will definitely look into that book.

When and why is the PSMA scan used?

What is the reason you guys are choosing RALP over treatment?

Does having radiation disqualify you in any way from having RALP later on?

I do have one main concern. The urologist that we are working with seems pretty young. I did a quick search and bringing up that he has been practicing since 2016. This does not make me feel very comfortable. I felt ok early on seeing this urologist but now that things seem to have gotten more serious I honestly don't feel comfortable. Not that he's done anything wrong because I think at this stage it's more of just following the motions of run this test and run that test. In looking online I see that he's been practicing since 2016, this does not make be feel very comfortable at all. How would you guys feel being in my shoes and what would you do in this situation?

One thing seems odd to me is that the doctor said that a lesion of 8mm was found (didn't mention where exactly) and a Pi-RADS 4 category was assigned, and that there's about a 40%-45% chance that it could be cancerous. In looking online however, I'm seeing that chances of cancer with a Pi-Rads 4 are more like 60%-75%. Does this strike anybody as odd for a doctor to give it such a drastically different % chance or is there more taken into account that I might not understand?

So far I understand the process of blood test PSA, the range you should be in, I understand why an MRI was performed, getting a Pi-RADS category, I understand why a biopsy is needed, ordering a biopsy (this seems tricky as everybody seems to talk about different kinds which I still am not too sure what to do), I also understand that the results of the biopsy will come with a pathology report which will provide a Gleason score if anything is found (I also understand the different scores and how they are assigned, though not educated yet on treatment options for each score).

As far as getting a pathology report. What exactly would happen if a biopsy comes back showing no cancer? Does this mean all is good and on you go, or does this mean you continue monitoring PSA regularly and most likely continue performing biopsies until something is found?

Determine if proton treatment is applicable. Not all cancer centers have it.

Psma pet scans give a clearer image of cancer cells. If you can see it, you can treat it.

I chose radiation because of the potential side effects of RALP. I had identified Dr Patel in Celebration Fl who had done 18,000 of the RALP’s but felt the MRIdian Viewray specifically was a choice that would work, with minimal side effects and better quality of life. For me, I made the right choice. We will see over the next few years. There are lots of grey areas with these choices.

I understood that RALP later on, after making the radiation choice, complicated the procedure but felt I made a good choice, especially after the Mirage randomized trial results on the MRIdian:(https://www.prnewswire.com/news-releases/mirage-phase-iii-randomized-controlled-trial-demonstrates-superiority-of-mridian-mri-guidance-in-stereotactic-body-radiotherapy-sbrt-for-localized-prostate-cancer-301660815.html. By the way, there is a machine in Lansing, MI.

I encourage you to get the Decipher test or similar. I felt that it acted as a backup to whatever my Urologist or the Pathologist said. It’s like a second opinion and the doctors consider it when they have it available. It shows an aggressive score and also indicates a single mode of treatment or more. Since your already unsure about the Urologist and they pick the pathologist, it makes even more sense.

Finally, I was put under Propenol for my biopsy so basically, I was out. Why not minimize discomfort when possible.

Sorry, also in Detroit,MI