Pi-Rad 5, PSA 8.4, (last year, 5.3)

Having said that, the idea that only performing the minimum amount of treatment based on age, quality of life and life expectancy is nothing new and has been around since the dawn of modern medicine. Someone in their 80's is far more likely to be offered palliative care than a radical medical procedure.

Given that PCa is a slow growing cancer, and that it is generally accepted that most men will die WITH PCa and not because of it - non-treatment is definitely an option in the older generation in order to maintain QUALITY of life in their final few years.

Now, you mentioned that this doctor was American and that adds another slant to it. Having lived in the US for 14 years, you develop an understanding of how the American health system works and the huge power, both financially and politically of the drug and medical care companies. The system works of action and procedures - not on let's wait and see. You are much more likely, regardless of age etc, to be offered a full set of procedures aimed at cure in the US than probably anywhere else simply because, for those that can pay and/or have the insurance, the medical resources are virtually unlimited.

The idea of getting a second and third opinion is also a stateside process - you might manage it under the NHS but you will probably be waiting a very long time.

You don't mention your age and where you live - both will influence what treatments are offered.

I'm having a biopsy tomorrow and if the result indicates that cancer has spread outside the capsule and potentially later becomes metastatic (almost a certainty ) making surgical procedure such as prostatectomy impossible or ill advised I'm wondering if anyone has ever considered to opt not to be treated with hormone therapy and radiation in the following months and years because especially with hormone therapy it does not appeal to me at all with the side effects and everything else. 

The side effects of hormone therapy including diabetes, impotence and other things are of great concern I feel but it seems many people or most prostate cancer patients accept the hormone therapy and chemical therapy if their Gleason score is in that number range (9/10) where surgery is not advised or possible. It is stressful just to think about all of this.

Thank you. 

Thank you, Sir. I'll keep that in mind. 

Just for the purpose of clarity, HT does not cause impotence - it causes a loss of libido. In other words, many men can still get an erection but have no desire to use it. The impotence is caused either by radiation damage to the nerve bundles (often 5 - 10 years after the RT was actually delivered) or by penile atrophy, which is irreversible.

Also, prostate cancer can be fully contained within the gland but still be metastatic.