PIRADS 5 MRI - Urologist said almost certainly Prostate Cancer

You have received great advices and comments from the survivors above. My comment regards the next biopsy that should,  particularly, target the spot identified in the MRI. The radioisotope used for the PET should be appropriate for prostatic tissues (PSMA, Axumin, F18-Choline) instead of the typical FDG that looks for tumor activity. I would add to the above opinions the need in getting a complete lipids test, including the free-PSA, testosterone and thyroid's T4 and T3, to try understanding the series of symptoms you describe above. Inflammation of a nerve (neuritis) could justify many of the effects you experienced. Anemia  can lead to extreme fatigue and it could be a cause from poor diet.

Best wishes 

VG 

Welcome to the Forum that nobody wants to join. 

You are reacting just like most folks who receive word that they may have, or actually do have, prostate cancer (PCa). It is a totally normal reaction, one that you will need to manage as best as you can over time.  I know, easy to say, but very hard to do.  You have come to the right place, though, as we in this Forum are all PCa survivors.  We are not doctors or medical professionals, and as such, we cannot, and will not, give any medical advice to you.  We are, however, experts in PCa survival from the patient's perspective, and we will freely give you our impressions and suggestions, and the results of our extensive individual PCa research efforts, from the patient's perspective.

The good news is that PCa typically spreads very slowly, allowing ample time for treatment options to be identified, implemented, and assessed.  For the most part, PCa is very treatable, with good prospects for a cure in many cases,.  And, in those cases where a cure is not possible, there are treatment options that can keep PCa under control for many years, even decades.  Most folks with PCa eventually die from other circumstances than PCa.

This is important.  The only test that can actually 'confirm' that you have PCa is a biopsy, which returns cancerous cells in the needle extractions of tissue samples.  You have also experienced the fact that not all biopsies return cancerous tissue, even though cancerous cells 'may' in fact exist in the prostate.  A biopsy, without any additional information regarding where precisely to take the needle samples is akin to looking for a needle in a haystack.  My thought is that with the results of the recent MRI in hand, your next biopsy will be very targeted, to obtain tissue samples from those specific questionable areas identified in the MRI.

Should the next biopsy confirm that you in fact do have PCa, your next step as a patient is to start your research on PCa, and there is a wealth of information on this topic, both here, and in many other places.  You will want to understand PCa itself, along with available treatment options, as much as you can, so that you can actively participate in subsequent discussions with the medical professionals regarding any treatment options. 

If it turns out that you do in fact have PCa, I strongly recommend that you find and engage a Medical Oncologist to be the long term leader of your PCa medical treatment team.  A Medical Oncologist has no professional preference for potential treatment options, such as surgery or radiation, and the Medical Oncologist is the expert in hormone therapies, which may be used in conjunction with other treatments, such as radiation. Personally, I've had PCa for over a decade, and my Medical Oncologist has been at my side for my entire PCa journey.  Surgeons and Radiation Oncologists have come and gone with their treatments, at the direction of my Medical Oncologist, but my Medical Oncologist remains my sustaining medical professional and consultant.

Other folks more knowledgeable than me will chime in with their perspectives and suggestions.  We are all here to support you.

I wish you the best of outcomes on your potential PCa journey, if in fact, it is confirmed that you do have PCa on your next biopsy.

Good luck on your journey.  If you can, try to tackle one issue at a time.  By all means get that second biopsy.  That will give you a clearer picture of what you are up against.  Again, good luck.