Hello Fozz and welcome. Sorry you have to be here but we have a great group of experienced folks on this forum that will help you get through this. I'll take a shot at answering your questions.

1. MRI and biopsy discrepancies. Yeah, that's not uncommon. An MRI can show suspicion of cancer but only a biopsy can diagnose for sure. Assuming the Gleason score is correct from the biopsy then the MRI/biopsy discrepancy is irrelevant. What is relevant is that prostate biopsy grading is as much art as it is science. I would recommend getting a second opinion on your biopsy slides from a major pathology center. Many folks here have used Johns Hopkins. There is a link in our sticky threads to show you how to do this or you can just Google second opinions on prostate biopsy at JHU and you will get info about how to do this.

2. PET scan. This is important. Get a PSMA pet scan and this can give you an indication as to whether or not the cancer has spread beyond the capsule. With your stats this is unlikely but you want to know as it may affect your treatment decision.

3. Decision between surgery and radiation. I had a G7 cancer and chose radiation for quality of life reasons. The surgery is a major operation and can lead to onerous sexual and urinary side effects. Radiation is likely to give you some short term urinary and perhaps bowel urgency that should go away quickly. With radiation there is a very small chance of secondary cancer way down the road. Both options are likely to result in total cure in your case.
You should definitely talk with radiation oncologists (maybe several) to assess your cancer. Don't take radiation advice from a uro/surgeon and vice versa.

4. Prostatitis and cancer. I didn't have that experience but it is likely your radiation doc may want to calm down the prostatitis before radiation. A surgeon will be cutting it out anyway so it's not likely a factor.

5. TRT and PSA. There are others on this forum that have dealt with that and are likely to chime in.

6. Encouragement. Take your time, do the right testing, see multiple doctors and do your homework. There are multiple avenues for a cure and cure is likely in your future.

Good luck and please feel free to ask any and all questions.

Jim

Hello Fozz, sorry you have to be here.

I will take a stab at this so first things first. I would consider getting a second opinion on the biopsy pathology to be sure of exactly what was reported. Johns Hopkins is well known for this service but other respected pathology groups can perform this also.

https://pathology.jhu.edu/patient-care/second-opinions

Would also suggest getting an opinion from a NIH designated cancer center.

https://www.cancer.gov/research/infrastructure/cancer-centers/find

MRI and Biopsy Discrepancies - Everything possible has happened. I started with a G7(4+3) from biopsy and ended up at G9(4+5) after surgery. Some men have had a number of negative biopsies before finally finding a small tumor with high risk G9 pathology.

PET Scan Insights - PSMA PET scan may or may not find out more. The PSMA PET scan is like the MRI in some ways in that it can not determine a Gleason score, only microscopic analysis of the cells can do that.

Decision Between Surgery and Radiation - These decisions become quite personal and you will have no end of radiation recommendations for a myriad of methods. Get the PET scan and second opinions done then wade into that decision. The urologist will recommend surgery as that is what he/she does. The radiation oncologist will recommend RT, duh! A decision for another day.

Experiences with Prostatitis and Cancer Together: No comment, never had together.

TRT and PSA Levels: No experience

Encouragement or Advice: Define favorable, treatment will probably be successful and you will die from something else. G7(4+3) means treatment is not optional but leaves most options available to you.

My concise signature highlights my journey. 72 now and the details are just a nightmare I prefer to forget about which the six month PSA testing reminds me of.

Fozzworth,
Man, I was thinking you are young to be diagnosed with PCa, but then remembered I was only 54 when I was diagnosed. Nine years have gone by since then. It’s a really good thing that you apparently have been keeping up with PCa screenings. The powers that be mostly discourage that these days.

I don’t have much to add that hasn’t been said. That G7 core that’s at 90% niggles at me a little bit, but as stated, it may not have much meaning. Out of curiosity did the Uro/Surgeon give you the spiel about doing surgery first, and then having radiation as a backup? Well, that’s kind of a trick of the trade PCa surgeons like to use when selling their services. It’s quite true, but for many reasons it doesn’t add up as well as it might seem. Also, you seem like a very diligent guy, please don’t get sucked into surgery because you just want to get it done. The Forum probably leans to radiation, and with good reason. There is so much that can go catastrophically wrong with surgery.

As said before, you would be very wise to get a second opinion on your biopsy slides.

I see no reason you won’t have a good outcome.

Good luck!

Greetings.

I am more paranoid than most here, but feel I should add my bit. IMHO, if they found G7 (4+3) there are likely some G5's that got missed and are rearing to go somewhere to do something you won't like much.

I initially got surgery + Luprolide chemo (Firmagon, then Lupron for 2 & 1/2 years) + radiation (72Gy) for my bouncing baby G7(3 + 4). All of that failed to get rid of the PCa. I then got put back on Luprolide chemo (Eligard) + Enzalutamide chemo (Xtandi) for 18 months. My (initial) team said no more surgery no more radiation, so I got a new team when the enzalutamide (temporarily) crippled me (in addition to several other pretty nasty side effects).

I then got 'ORIOLE' type radiation (another 106 Gy, 3&1/2 years ago). PSA is back up, just got a Gallium 68 PSMA PET scan last Friday, waiting for the photos. Yeah, surgery has some unpleasant side effects that you may or may not initially avoid with radiation. So does the Luprolide chemo. I am glad that I concentrated on the cancer and just tolerate the side effects.

Such excellent responses!

All good advice. My 2 cents, find a Cancer treatment facility that is a “Center of Excellence “. This where you find a “Team “ that can help guide you through this. Tell the group what area of the country you live in and they will help you find the best center near you , you deserve the best treatment available.

The NCI has a ranking of The Centers of Excellence

Hoping the best outcome for you