Prostate cancer treatment option

Sorry for the bad news. With a G9 and a psa of 58 there is an extremely high probability that the cancer is already systemic. Is there a reason the doctor told you it has not yet spread? Has he had the latest PET scans? CT or bone scans will only detect late stage matastatis.
Any treatment he chooses, ADT and even Chemo should be strongly considered in addition. Surgery will most likely need follow up radiation, so it would make sense to start with radiation, or a combination of brachytherapy and external radiation along with ADT and even chemo.
My philosophy is for non aggressive cancer is to choose the least invasive treatment. For aggressive cancer like your husband's, throw everything in the book at it.
Ask you doctors to run nomograms on your husband's stats.
Best of luck

Hyderhari,

Welcome to the forum and I'm sorry to hear about your dad's recent diagnosis, but don't despair. This recent news and his prognosis for the future are nowhere near as dismal as it may initially appear. Although I'm a wee bit younger than your father, my diagnosis was and is very-very similar to his, and there is plenty of reason for optimism. Advances in the detection and treatment of prostate cancer have been tremendous in recent years, so folks like your father and I, and countless others, have great promise to hold to.

You can see the details of my own diagnosis in my signature block below, and like you are about to begin doing now, I have spent a considerable amount of time in recent months, researching the various treatement options and their success rates. When I first set-out, I was thoroughly convinced that as a high-risk, locally advanced prostate cancer patient with high PSA and GS-9 score, I had been given a death sentence, and that surgery was my only true hope for a possible cure. I was wrong. In fact, I couldn't have been more wrong.

I have since learned that well-planned radiation events (BBT and IMRT), coupled with ADT regimens (Casodex and Lupron), can and likely will offer me less adverse side effects and better overall survivability over the long-term than surgery alone ever would have. I now trust in this approach wholeheartedly, and I remain beyond optimistic. In fact, rather than dying 4-5 years from now (as some fearmongers seemed to enjoy telling me months ago), I plan on living 12-15 more years after completing this so-called 'triple-play' treatment plan, and my radiation oncologist (RO) fully agrees with that prognosis.

So, I encourage you and your dad to keep your heads and spirits held high, and go full-sail at this thing, from the initial research and medical consultations required, to the most aggressive treatment plan you can formulate. Locate and secure a well-qualified radiation oncologist (RO) and medical oncologist (MO), and don't hesitate to travel to the experts, if necessary, as you may not be able to accomplish it all in your own hometown.

Anyway, good luck on your journey, and don't be afraid to pose any and all questions that you might have in the future for the experts here on the forum, because there are scores of them here.

hyderhari-

With his very high risk PC, I think he should get the DCFPyL PET scan offered at NIH for free. Call Yolanda (Yolanda McKinney, R.N. (240) 760-6095) tomorrow if possible to see how soon he can get in:

/clinicaltrials.gov/ct2/show/NCT03181867

I think with his high risk factors (predominant pattern 5, very high PSA, T3b) it's very important to rule out metastases that may be too small to be picked up on a bone scan/CT.

if he gets an "all clear" there is a clear oncological advantage to brachy boost therapy over surgery with adjuvant radiation. 10 year incidence of metastases was 46% among men who pursued surgery first, but only 13% among men who had brachy boost therapy:

/pcnrv.blogspot.com/2018/03/brachy-boost-therapy-and-surgery-extend.html

They don't offer this therapy everywhere. Where is he located?

I agree that surgery is not a good option taking into account all the different high risk factors, specially the local extension. It is almost sure that he would need radiation after his prostate is removed. There is some indication that prostate debulging maybe useful even in metastatic cases but age is also a key factor to discard that road for him. As other said, urgent HT and later radiation in the hope of a definitive cure is the most reasonable course.

hyperhari,
After 10 years and going through 6 different doctors telling me my high psa was due to BPH and not prostate cancer I finally found a doctor (a specialist in PC) who said you must identify ALL causes of psa before you can make a DX. A G9 puts out LESS psa than lower Gleason grade tumors. Unless he has a large transition zone tumor a psa of 58 can only be explained by a prostate infection or micromets to the lymphatic system.
The PET scan tha Allen recommended is an excellent way to rule out micro mets, A combidex scan is another way. If micro mets show up, (which is a very high probability) A treatment option could be pelvic radiation or full body radiation in addition to radiating the prostate. Treating micro mets early increases the probability of success.

He already took Ga-68-PSMA-11 PET scan and it confirmed that it is not spread elsewhere. Doc mentioned that this test is 98% accurate. Are there any other tests that we can take other than the following that has already been done:

1. blood PSA
2. MRI
3. Bone scan
4. Ga-68-PSMA-11 PET

The Ga-68-PSMA-11 PET scan is the best test there is currently. You can trust that and do not need any further tests. New metastases may develop in the future but for now you should plan without thinking of that.

I had four of these scans in the past and will have another one soon to monitor my metastases and recurrences.

Thank you for all you valuable suggestions. My dad is to undergo RT+HT. But before that doc has advised him to undergo TURP as he has difficulty urinating. I was thinking that HT can shrink the tumor and will improve the urinary problem but now it looks like he has to undergo TURP before RT+HT. Could you please let me know the following?

1. What are the side effects of TURP? Has anyone undergone TURP before RT+HT?
2. After TURP, how long does it take to start the actual RT+HT treatment and is it fine to wait till TURP wound heals in my dad's case as his is locally highly advanced?