New patient

Welcome Joe
Joe, welcome to the forum and I am sorry to read of your father's diagnosis.

Your father's diagnosis of a Gleason 9, a Gleason 7, and a Gleason 6 are indications that while he has various stages of cancer growth within his prostate, the Gleason 9 is the one that is the most cause for worry. Gleason 9 cancers are stages of prostate cancer that are aggressive and very advanced. The areas that are high grade PIN are simply areas where there are lesions evident where the cells are dividing more rapidly than the benign cells. PIN is thought to be a precursor to prostate cancer but in your father's case it doesn't really matter as there is plenty of evidence of cancer present without the PIN.

There is other information you father probably has in his records that would be useful to know such as his PSA history (a record of PSA readings at various times in the past) which can be used to calculate PSA velocity and PSA doubling times which are an indication of how aggressive your father's cancer is behaving. Whether or not the urologist detected anything abnormal during the DRE such as bumps or hard spots on the prostate, how large the prostate is (they should have measured it via ultrasound when they did the biopsy), and the results of the bone scans that they almost always take when a positive cancer diagnosis is obtained from a biopsy sample.

Treatment options are many and varied and there is quite a bit of controversy among prostate cancer professionals about how to address prostate cancer even at low risk stages. At high risk stages there is even more controversy that range from doing nothing to pursuing an aggressive treatment regime. The decision on which course to pursue is pretty much left up to the individual lay patient. Depending upon which part of the country you live in Medicare may allow different treatment options.

Typically the treatment options open include surgery to remove the prostate, a variety of external radiation techniques, proton therapy, cyrotherapy, brachytherapy, hormone therapy, and so on. In advanced prostate cancer a combination of therapies are frequently pursued.

Regardless of what the diagnosing urologist recommends, please encourage your father to seek out second and third opinions. Most of the initial diagnosing doctors are surgeons and 90% of them recommend surgery as a solution. Your father should also seek the opinions of radiation oncologists that specialize in prostate cancer, and a prostate cancer oncologist as a minimum. Keep in mind that most treatment options carry with them the potential for adverse side effects that impact quality of life in terms of sexual function and urinary and rectal continence. Hormone therapy can cause hot flashes, breast enlargement, increased weight gain, and significant mood swings. There are no hard and fast rules on side effects. Each man is unique and a treatment may have little or no impact on one man while another with a similar diagnosis has major difficulties.

The consultations can be confusing for lay people unfamiliar with a lot of the terminology. When your father visits his doctors to review treatment options it would be good to have someone there who can be unemotional, take notes, and have a list of questions to go through with the doctors.

Best of luck to you and your family as you sort through this.

K