cdm39,
I am so sorry you were rushed to biopsy and are forced to deal with this now. You are the poster child of why screening should not be done without a lot of thought, eliminating other sources of PSA elevation first. Many men your age would find insignificant amounts of prostate cancer (and I very much hesitate to call your dysplasia "cancer") like you have if they probed for it. Unfortunately, now you have to deal with it.
There's a small chance that the biopsy was misread. Try getting a second opinion from one of the following:
www.bostwicklaboratories.com/services/laboratory-services/second-opinions.aspxpathology.jhu.edu/department/services/secondopinion.cfmwww.ourlab.net/secondopinion.aspThe first thing to do is slow it down. You've been rushed too much already, imho. PCa is typically very slow growing, and in the insignificant amounts they've detected thus far with you, it would typically take years before it became a problem, if then. Remember, in the days before PSA screening, most men died with it, rather than of it. They know that from studies they did on cadavers that died of something else.
Your PSA was probably elevated by something else in addition to the PCa. This is important because if you decide on active surveillance, you'll want a PSA that only reflects the cancer there. The biopsy pathology report may give you a clue. It may tell you there was some inflammation (prostatitis) or hyperplasia - an enlarged prostate (BPH). You may be able to control the former with antibiotics, the latter with finasteride or dutasteride. This will establish a new, more useful PSA baseline for you.
There are some doctors that agree with you that many Active Surveillance protocols for cases like yours are too onerous. Depending on the program you hook yourself up with, there will be multiple annual PSA tests and DREs, and a follow-up biopsy in a year, perhaps with some advanced imaging like mpMRI or CDUS (see below). Sometimes, after a year of finasteride, the PCa becomes undetectable.
Another sort of halfway option for an insignificant amount of Gleason 6 like yours is to treat it "focally." This means they use some form of ablation like cold (cryo), ultrasound (HIFU), electroporation (Nanoknife), laser, RF, photodynamic therapy etc. to only eliminate the focus of cancer and leave the rest of your prostate alone. This depends on very good imaging. Dr. Bahn in Ventura is one of a very few world experts at using color doppler ultrasound (CDUS) to locate the lesion and he uses cryo to ablate just that lesion. You would still have to monitor your PSA after that, but that might give you confidence that things have been slowed down quite a bit or stopped.
Other options involve "radical" therapy -- treating the whole prostate. In addition to surgery, there are several kinds of radiation where the odds are that there will be fewer and milder side effects. These include SBRT, HDR brachytherapy (temporary implants) or LDR brachytherapy (permanent seeds). You'll have to separately talk to experts in each of these -- every specialist usually recommends and knows most about
his specialty. But you have lots of time to investigate any of this.
Again, I'm sorry that you have to contend with these issues at such a young age.