Sorry to hear the news of your diagnosis. You are likely to get a lot of good advice here. Sometimes your prostate can push up against your urethra, causing urinary symptoms, even if your prostate is not particularly large. There are also some bladder issues that can cause urinary symptoms, which have nothing to do with the prostate. In terms of questions to ask -- I would first get a copy of your biopsy report, so you can see some of the detail. Then I would ask the urologist to arrange for a second opinion reading of the biopsy slides, by a pathologist who has expertise in prostate pathology. Gleason scoring is important, but it is not so easy. Before you use your Gleason score to make treatment decisions, you want to make as sure as possible that it is right. Experts you might consider include Professor Helmut Bonkhoff
www.prostapath.de (don't worry about
the fact that he is in Germany -- that is no impediment -- he is accustomed to working with overseas docs and patients); Jon Oppenheimer (
www.ourlab.net) ; David Bostwick
https://www.bostwicklaboratories.com/patientservices/primary.html; or Jon Epstein at Johns Hopkins. You might also ask your doctor whether he sees any value in getting a PX+ test by Aureon. This is a relatively new test that purports to evaluate the agressiveness of prostate cancer. If you are considering this urlogist as a surgeon, ask him whether he does
open or laproscopic surgery, and how many times he has done each. If you are going to go the surgery route, you want someone who has done at least hundreds of them. This is one type of surgery where experience really matters, in terms of outcome. I would also suggest you ask him for the name of the best radiation oncologist he knows -- preferably not one affiliated with his institution. You can talk with that person about
the radiation options, which, as you point out, would include external beam radiation (these days, mostly IMRT), or seeds, or sometimes both of those. Urologists (who are surgeons) and radiation oncologists often have different perspectives -- so it is worth hearing from both of them before you make a treatment decision. You might want to read a book or two about
prostate cancer too. There are dozens of books. The one I like best is Steven Strum's "Empowered Patient's Guide." Strum is a leading expert on prostate cancer, and you can get a terrific education by reading this book. It would also give you good ideas for questions to ask your doctor. Best wishes, Medved