My husband has the BRCA2 gene mutation. We’ve known this since 2015 and that he was at a higher risk for prostate cancer which he now has. Ten people from the two generations above him died from cancer including his mother. His PSA has been inching up over the years and is now at 22. He is 67 years old; GL 4+4=8; 13 out of 22 cores positive; large prostate at 97ml; bone and CT scan negative for spread. No PSMA-PET scan requested.
Fusion Biopsy on 3-7-23 results: 31 of 22 cores positive—
Right prostate, mid lateral, 1 of 1 core 60% 7mm, GL 4+4
Right prostate, mid medial, 1 of 1 core 30% 3.5 mm, GL 4+4
Right prostate, apex lateral, 1 of 1 core 70% 6 mm, GL 4+4
Right prostate, apex medial, 2 of 2 cores 95% 10mm, GL 4+4
Right prostate, apex (area of interest from MRI on 12-1-22 PI-RADS Cat 5), 7 cores 80% 6 mm, GL 4+4; perineural invasion identified.
Left prostate, apex medial, 1 of 3 cores 3% .5 mm; too small for grading.
Other 7 cores, benign
Total cores 22; 13 prostatic adenocarcinoma
Other significant consideration:
When he was 30, he fell off of his bike down a 25 ft drop over a bridge and sustained significant pelvic/nerve damage. Since then, he self-catheters to urinate and does manual removal for bowel function since his sphincters are shut closed.
Of all of the side effects from cancer treatments, his biggest concern is damage that would cause his elimination process to change for bowel especially and secondly bladder because he has no feeling as to when he needs to eliminate.
He started bicalutamide two weeks ago and is due to start Lupron soon. His local urologist (we live in OC, CA) suggested that radiation would be a better choice for him than surgery due to potential incontinence issues. However, upon obtaining a second opinion from RO Dr. Kishan at UCLA, he recommended surgery saying that potential bowel problems and scar tissue will be less with surgery than with radiation. Dr. Kishan also presented this case at his weekly Tumor Board meeting and they, too, were in agreement with surgery. Dr. Kishan referred us to Urologist Dr. Rob Reiter, UCLA, which our HMO denied. We paid for this visit to Dr. Reiter out-of-pocket today as our HMO denied further out of network care. Dr. Reiter agreed that surgery would be better since the location of the cancer is very near the rectum and recommends a PSMA-PET scan prior to starting Lupron.
My husband is in excellent shape and works out on a Peloton for an hour 3x/week.
Questions are: With the BRCA2, we know that cancer can spread faster than normal. So how risky is it for him to stay on Lupron for 6 months to potentially shrink the prostate and lower PSA so that we can change insurance from HMO to one that UCLA accepts starting Jan 1st and then have Dr. Reiter do the surgery? Or we welcome any suggestions on how to get the HMO to release him to Dr. Reiter faster for surgery treatment? Also, we welcome all thoughts on potential long-term impacts to consider with his BRCA2 relative to prostate cancer return.
I apologize in advance for the long post but have so appreciated this forum in the few months that I have been part of it.
Prostate Biopsy Results
newly diagnosed Gleason 7 3+4 
Advice - Surgery or Radiation?
Here we go.......
