Second opinion given my diagnostic?

Welcome and so sorry you had to find your way here. There is absolutely nothing wrong with getting a second opinion. I was diagnosed in May and already had a history with a group of doctors due to my wife's cancer some years ago. I placed a call and my records were reviewed. My wife's oncologist told me that if he ever had a diagnosis that looked like mine, he would call my doctor for treatment. That was good enough for me. I never had to make a decision about surgery since the nature of my disease eliminated me as a candidate, but I have always felt I was doing the right thing because of that second look. Please let us know how your appointment went. Best wishes.

By all means seek a second opinion from a center for excellence. You are young for this disease and your quality of life matters because you likely have years to live with your choices. Lately those with cancer contained within the gland have choices other than gland removal. The Tulsa procedure might be applicable to your case. You won’t lose urinary continence and may retain sexual function. My case started with an urology surgeon who promoted removal and non-nerve sparing at that. I struggle with urine leakage and sexual function is but a fond memory. Don t rush and do your research this is your life.

You are a Gleason eight. Under no conditions is active surveillance an option with a Gleason eight. The other lower numbers are irrelevant.

You could have radiation or surgery, Though at your age surgery is usually recommended Because if you have a recurrence, they can do radiation. I picked surgery at 62. You could look into proton radiation, which has a very low chance of damaging other organs. The biggest problem is that It will be difficult to get an erection after surgery, If they can spare the nerves during surgery, it can help a lot, And can reverse the problem. They’re still are options that will allow you to have an erection after surgery using injections or implants.

You need to speak to a radiation oncologist to discuss that option.

Have you had a PSMA pet scan. That is really critical to figure out what’s going on in your body.

Depending on the PET scan many different things could be recommended.

If this has not been offered you, you need to go to a center of Excellence or find a Genito urinary Oncologist to help direct your case.

If you seek a second opinion, do it quickly. Prostate Cancer is slow growing but you don't have forever. Be sure to go over the risk factor of your cancer if it's high risk etc. also It may be Aggressive. Have you had a PSMA and MRI, if not your Urologist may send you for one or both. Also the surgeon that works with your Urology office may be booked solid and it could be Months till your RARP. It was 3 months from my Diagnosis to surgery.

Welcome to the Forum and welcome to the club no one wants to join. This forum is great and we all support each other! We all have different perspectives. The RP is scary but your surgeon might be able to do some serious nerve sparing.

I was also diagnosed with Gleason 4+4. At first I was seriously considering RT but in the end choose RARP. I am 52. If the cancer is contained inside the prostate, RARP gives the best odds for cancer control because of the salvage RT option and a high ex-ante probability that you won’t need it. Definitely get a PSMA to understand the aggressiveness of your cancer.

Definitely get more opinions and go to a center of excellence. Whether you decide on RARP or RT, you want to go with someone highly experienced and specialized.

With G8, the RT person will likely recommend SBRT with a brachytherapy boost and ADT. The risk of érectile dysfunction with that aporoach is higher than with RARP and full nerve-sparing, even though it may take a bit to materialize.

Both Jeff and Jay gave you excellent advice, I would just add that you should ask for Decipher test (one that measures level of aggressiveness of your cancer) which might hep with choice of a treatment
Wishing you the best of luck with everything 🍀

And not all prostate cancer is slow growing, even. Some (like mine when I was 56) can metastasise *very* quickly.

Getting on ADT as soon as possible will help the OP, because it can put the brakes on the cancer (at least for a while) and give them and their cancer team more time to plan treatment.

I forgot to mention, Was there anything else in your biopsy? The following issues are important and Can mean that your cancer is much more aggressive.

cribriform, Seminal vesicle invasion (SVI). extra capillary extensions (ECE) or intraductal

Ultimately, the choice of treatments is your call, not theirs. (Your doctor is there to provide advice and recommendations.)

Per the NCCN guidelines (see attached), the recommended treatments for a Gleason 8 (high risk prostate cancer) is (1) radiation treatments + 12-36 months of hormone therapy or (2) prostatectomy.

It’s your decision.

(For my 7(4+3), my urologist recommended surgery. (Most urologists will usually recommend surgery.) Radiation being an option, I chose proton radiation + hormone therapy.)

@animate
Talking to you from my personal experience with my prostate cancer.
Explore and consider gettng futher tests:
Decipher test. This will help define the aggressiveness of your cancer. It can be done with existing biopsies. My Decipher reduced my stated aggressiveness from intermediate to low risk.

PSMA: A test to see if cancer has spread outside of your prostate.

Second Opinion: Can help see if your diagosis and treatment options from different sources to help guide you on your decision. Remember it is your cancer, your body, and you decision of what is best for you.

Get an appointment with R/O: They can discuss radiation treatments. These treatments have improved so much over the years. It is another option beyond surgery that you should decide on your own if is what is best for you.

Do research on both surgery and radiation: Look at pros and cons. I did not see you mentioned hormone treatments but sure it will come up. With a =8 and if me would definetely get the Decipher and PSMA.

If you want to get a ton of information on proton radiation, prostate cancer, research, pros and cons of treatments including surgery, and two free books famous for prostate cancer consider contacting UFHPTI and asked for their information packet. It is free and send FEX EX. No pressure to go to them they are a State of Florida facility and all doctors and tech are state employeees salaried.
Good Luck!