thoughts on what I should do.

As multiple others on this forum have said in the past, welcome to the club no one wants to join. My best piece of advice is go to a recognized "cancer center of excellence (CCOE)" if that's an option available to you. Google it and you'll easily find one. I did (Mayo Phoenix) and I was very happy I did. I felt the advice and care was outstanding. Also, I'd recommend Dr. Patrick Walsh's Guide to Surviving Prostate Cancer Paperback – October 3, 2023. It's on Amazon and it's the best $20 I ever spent. It really helped educate me on some key points in my decision making. It's organized in a way that makes it pretty easy to drill down on things applicable to your specific situation. One other thought I'd share is that for me (I was diagnosed on 3/2024) the more you educate yourself the better you'll be able to discuss treatment with prospective providers and the better you'll be able to make the decisions you'll have to make. It's like drinking from a firehose at first, but it's worth the effort to get knowledgeable as quickly as possible. I guess one thing that surprised me was I'd never really been seriously sick before, so I didn't appreciate that I'd have to ultimately select my course of treatment. Yeah, you'll get recommendations, but the final decision on how you proceed will ultimately come back to you. So it's pretty important to understand your options at each step as thoroughly as possible, especially since selecting an option might impact other options going forward. Also, even if you can't go to a CCOE don't hesitate to get a second opinion from one regarding treatment recommendations. Since there's nothing to be gained by an in-person physical exam, it's pretty easy to get a second opinion since they only look at your test results anyway. Best wishes.

just got off the phone with mayo clinic in Jax Florida. One of the CCOE places near me. $5000 just for a consult. completely out of my range of available funding. guess let it run its course or let the VA hack on me are only two options.

I understand your panic completely...when my doctor said I had prostate cancer it was like a deer in the headlights...he did say this isn't what is going to get you and recommended a biopsy, which i did and then on return to his office he says" yep...this is going to get you". I saw four urologists and like you the radiation for me was concerning since your right no one would operate after radiation. Two others wanted to do the DaVinci robotic...the last, Dr Catalona at Chicago Northwestern Medical Center. My wife and I saw him and he insisted nerve sparring radical prostatectomy needed to be done by hand so the tactical feel enhances the accuracy of the surgery. This was January 2, 2020 so it may be different now. We chose him to do the surgery. I never had any incontinence and still don't, and I am still cancer free after 5 years...thank God. The other gentleman is right...it has to be your decision. Good Luck and God speed on your decision, I'm sure you'll choose the right person to help you through this tough time...Amos

First: sorry to welcome you to the club. We have no secret handshake, it was voted down.

Second: NOBODY here is a substitute for a doctor, please be your own advocate and seek additional resources. That $5K seemed super pricey for a consult, you can talk to a doctor for a couple hundred dollars generally. Call around, you'll find plenty cancer center's of excellence facilities that will likely give you another opinion for much less. I recommend at least two more urologists, medical oncologists and radiation oncologists so you can get a full picture. You might also request a Decipher test to really gauge your cancer since a biopsy is only part of the picture.

Third: Gleason 4 + 3 is aggressive so you could end up with multiple treatments. At such a young age, doctors may recommend surgery over radiation because you will live long enough to see the potential side effects of radiation - and radiation is still an option after RARP. I'm 54 and that was the universal recommendation so I wouldn't be surprised if it was for you at only 48. Once you hit mid 60's or more, radiation becomes more a part of the conversation as you are less likely to get another cancer as the result of radiation or suffer the side effects before the end of your natural life.

I am fortunate enough to have non VA insurance, I knew that when the sh*t hit the fan I didn't want the VA coverage, but please consider that even if it's $5K or $50K, this is your life - of which you still have a lot of. Your cancer is more aggressive than some, more than me at 3 + 4, so it needs to be addressed.

So sorry to hear your news

Some people here have mentioned that it *is* possible to have surgery after radiation these days, unlike in the past. Perhaps one of them will share the info (I don't know it myself).

The other situations where radiation is recommended when you're still young are when there's suspected local spread (radiation can get cancer just outside the prostate, while surgery can't) or if there's already distant metastasis, as was my situation at age 56.

While there are lots of nuances, surgery and radiation have the same overall survival rate, so "just having it removed" doesn't necessarily improve your chances over radiating it. Both surgery and radiation can have long term side-effects, so again, no free pass.

Have you been offered genetic testing? That can help refine how likely it is that the cancer will spread, though nothing is for certain, of course.

Best of luck!

Sorry to hear it'd cost you that much, but it's good you responded because some others on this forum might have some cheaper options for a good second opinion. Best wishes.

I am puzzled about your results. It only mentions two positive cores out of two cores taken. How many total cores did they take? If they took 12 and only two had 4+3 then you are not in too bad shape. REAL treatable.

They also don’t mention how many cores had 4+3. Usually a report will show every single core and what the result was for each one.

They would probably prefer to do surgery so they can figure out whether you have Ductal cancer, which is more aggressive Of course they could do another biopsy concentrating on the area that has the ductal appearance. So many issues.

Some doctors will do surgery after radiation, but it’s not very easy to do that.

You can get savage surgery after radiation, but they essentially just scrape out the goo that is leftover. It is still generally recommended, at least by all 9 of my docs, to do surgery first because radiation can cause side effects that may not manifest for 10-20 years down the road and salvage radiation is preferred over salvage prostatectomy as second options. Plus you can get 100% results on your cancer once the prostate is out and able to be analyzed.

14 total cores

Sucks to join this club, became a member at 55. It's not easy when you are told that you have prostate cancer after a biopsy, 14 cores, 12 came back positive. More than half of the organ was rotten based on the various scans and biopsy that showed the growths close to the wall and nodes. The alternative of radiation did not seem a good option to me due to the length of the treatment and my lifestyle. So, the decision to have the surgery was made and had the RP over a year ago.
Ultimately the decision to have the surgery is yours! Unfortunately, with PC not doing anything was not an option at least for me, after several years seeing the PSA numbers rise. All I can tell you is that depending on the surgeon and what they take out you may end up with ED, that can be treated with Trimix injections unfortunately applied directly on the side of your penis, that will allow your tool to work for "recreation". Incontinence was able to overcome with Kegel exercises.
But you will have a long life to live, hopefully free of other cancers. Best of luck in whatever treatment you choose!