Newly diagnosed treatment option questions.

Hi All, I was convinced at a party before Christmas by a friend who is passionate about Prostate Cancer to take a PSA test. So drunk at a party I ordered one online. Did the test and sent it back and wasnt expecting anything unusual. Anyway it came back at a PSA level of 44. I am a 56 year old married with kids.

So the NHS kicked into action and GP did another PSA test which came back at 38. Went for CT, Radio Isotope Xray and MRI. then was sent for Biopsies after the MRI result. 24 biopsies that was a treat I wont forget. ANyway finally got a appointment las Monday and was told I had localised Prostate cancer with a Gleason of 7 (4 + 3).

I was told i had option of Robotic surgery or Hoemone therapy for 3 months then EBT. I had a call with a friend who is in Nuclear medicine and he suggested Focal THerapy might be an option, but having investigated I think because my cancer in spread all over my prostate this isn't an option. (Please feel free to disagree as Focal looks like a much nicer and quicker option). 

I am fortuinate enough to have Private medical so will be going down this route. 

Here is the Medical stuff. 

Synopsis:

Gleason 4 + 3 = 7 ca1 prostate 9 out of 24 cores 90 to 95% pattern 4, up to 95% involvement of single core, no PNI, involved right anterior and posterior, left anterior and mid MRI Likert 5 bilateral peripheral zones within 33cc prostate

PSA at diagnosis 38

CT CAP right adrenal lesion ? benign

Bone scan normal apart from left ankle corresponding to recent ankle fracture

Plan:                                                          

For MDT tomorrow to ratify scans and review adrenal lesion

Whole gland therapy options discussed today

Referred to surgery and oncology to discuss further management Update patient after MDT (nothing changed after MDT except further CT to look at anomaly Adrenal gland).

Thank you for seeing this 56 year old insulin dependent diabetic who has recently been diagnosed with intermediate to high grade prostate cancer.

He asked for a private PSA after his friend was diagnosed and this came back at 44 with a repeat level with the GP at 38. His subsequent MRI showed some high grade (Likert 5} changes within both peripheral zones of a 33cc prostate and he subsequently underwent some biopsies.

These have shown Gleason 3 + 4 =7 disease with predominant pattern 4 with 9 out of 24 cores involved, with up to 95% in a single core. The disease is bilateral and fortunately not associated with perineural infiltration. 

He underwent initial CT and bone scan staging which has picked up an incidental right adrenal lesion which we will review at tomorrow's MDT. The abnormality on the bone scan within his  left ankle corresponds to a fracture last November which he sustained whilst ice skating.

 I met with him and his wife this afternoon and went through the diagnosis and potential treatment options including robotic assisted laparoscopic prostatectomy and external beam radiotherapy with neo-adjuvant hormonal manipulation.

Questions based on the above.

1. Am I correct about Focal treatment. 

2. Should I be asking for a PSMA PET Scan?

3. Interested to hear of personal experiences of Hoemone THerapy and side affects.

4. Interested in personal experiences fo Surgery as I have had very different views of this, from at 56 I wouldnt even think about it as side affects (Incontenence both types could be dibilitating at my age). 

5. Not sure why i was told 90 days hormone therapy ant then radio. Everythign i read says Hormone terapy for months or years after Radio?

I think at the moment I am veering toward Radio and Hormone rather than surgery.

Just to top it all off i was made redundent in the same week. It never rains..........

Much appreceiate your help.