I'm 49 and other than this, in great health. My PSA has slowly been rising from 1.8 in 2008 to now 3.5 in 2012. I've also been taking propecia for about 12 years, so my PSA is artificially low. Free PSA 2% (very very low) 1st Biopsy in May 2011 - all negative. DRE normal - in fact the Doc said "amazingly normal" 2nd Biopsy in March 2012 after MRI to pinpoint areas that looked suspicious - 1 core positive out of 13. 15% involved, 3+5=8. 2nd opinion on biopsy pathology at John's Hopkins - 4+5=9, 40% involved in one core - dang, wrong direction! Bone and CT Scans negative - but I realize with an 8 or a 9, these are not very accurate tests.
I'm seeing a very top Urologist/Surgeon in Chicago and may go for a 2nd opinion at MD Anderson in Houston.
Even with a likely G9 - I'm still leaning towards surgery - and not so much from the 'get it out' feeling, but just to be able to get a complete pathology report, know exactly what I'm dealing with, and remove that variable from the table. At only 49 - I'm not looking for a 10 year survival rate - I want 20 to 30 at a minimum!
I haven't been offered any sort of HT yet - I understand that's sometimes an option even before surgery for a G9, not sure if I should pursue that or not?
I guess my other question is - is surgery really worth it for a G9? I keep clinging to the fact that even if you double my PSA due to propecia, it's still low, under 10 - it's got a very slow velocity - my DRE is totally normal, so the hope is it's small and had to be found with an MRI - so I may get lucky with surgery. On the other hand if I've only got a 5% or 10% shot with surgery and will need radiation, maybe I should consider other things???