Husband Prostate Cancer diagnosis review

My 62 yo husband was recently diagnosed with prostate cancer. Gleason 6. Grade 1.

We received the biopsy results via Mychart. A week passed and he sent a message asking her to call him. The doctor messaged she was unconcerned about his results and would discuss it a couple of weeks later at the follow up visit.

At the follow up visit, she spent less than 10 minutes with us. She said these are "great results" and fluffed it off as nothing. She said she will get to know him quite well as she recommends active surveillance with PSA tests, MRIs, and biopsies on a regular basis. We asked a few questions and she assured us his test results weren't concerning. He asked about the perineural involvement and she said she has never known it to metastasize from that area. No issue.

We left feeling a little frustrated at the hurried conversation but felt confident about her recommendation, as she barely touched on anything else....radiation, surgery, etc. Just active surveillance. She is highly regarded in the field. She specializes in prostate and kidney cancers.

Later, I read her very detailed aftervisit summary on mychart and it said she had a lengthy conversation about ALL of his alternatives including several non-traditional therapies. NOPE! She also billed us for a lengthy appointment. NOPE!

Now, I have trust issues. Why write all of that stuff when less than 10% of it was discussed.

I was hoping someone could take a look at his circumstances and let me know if we should seek another opinion.

Background:

Very healthy, non-smoker, non-drinker, exercises, eats well, and never overweight.

Last year, he experienced unintentional weight loss and his PSA went from 5.2 (same level since 201😎 to 6.4 in 6 months time. His PCP wasn't concerned at the weight loss or the PSA increase, but I insisted on a urology referral.

He saw the urologist's NP who recommended an MRI and a biopsy. His PSA was retested and was back to 5.2. He is an avid cyclist and refrained from riding his bike for a couple of weeks prior to the retest.

The MRI impression was:

Lesion #1: PI-RADS 4 lesion left peripheral zone, at the apex. Degree of restricted diffusion suggest clinically significant lesion.

Peripheral zone: Area of significant restricted diffusion at the left
peripheral zone, at the apex, with associated T2 hyperintense signal and early DCE. Lesion measures 0.9 x 0.4 x 0.6 cm (0.21 cc)

He had an MRI fusion biopsy a couple of months later.

Urologist chart summary: 51 cc gland, PIRAD 4 lesion L apex. 4 cores of GG1 + ASAP, including within the ROI.

(No mention of perineural invasion)

Biopsy report:

DIAGNOSIS
A. Prostate, right base lateral, needle core biopsy:

Benign prostate tissue, negative for malignancy.



B. Prostate, right mid lateral, needle core biopsy:

Benign prostate tissue, negative for malignancy.



C. Prostate, right apex mid, needle core biopsy:

Prostatic adenocarcinoma, Gleason score/pattern 3 + 3 = 6 (grade group 1).
Carcinoma involves 7 mm of aggregate biopsy length 15 mm (45-50%).
One of one core is involved.



D. Prostate, right base mid, needle core biopsy:

Benign prostate tissue, negative for malignancy.



E. Prostate, right mid mid, needle core biopsy:

Benign prostate tissue with chronic inflammation, negative for malignancy.



F. Prostate, right apex lateral, needle core biopsy:

Benign prostate tissue with chronic inflammation, negative for malignancy.



G. Prostate, left base lateral, needle core biopsy:

Prostatic adenocarcinoma, Gleason score/pattern 3 + 3 = 6 (grade group 1).
Carcinoma involves 6 mm of aggregate biopsy length 16 mm (38%).
One of one core is involved.


H. Prostate, left mid lateral, needle core biopsy:

Benign prostate tissue, negative for malignancy.



I. Prostate, left apex mid, needle core biopsy:

Atypical small acinar proliferation (ASAP).



J. Prostate, left base mid, needle core biopsy:

Prostatic adenocarcinoma, Gleason score/pattern 3 + 3 = 6 (grade group 1).
Carcinoma involves 8 mm of aggregate biopsy length 13 mm (60%).
One of one core is involved.
Perineural invasion identified.



K. Prostate, left mid mid, needle core biopsy:

Benign prostate tissue, negative for malignancy.



L. Prostate, left apex lateral, needle core biopsy:

Benign prostate tissue, negative for malignancy.



M. Prostate, region of interest, needle core biopsy:

Prostatic adenocarcinoma, Gleason score/pattern 3 + 3 = 6 (grade group 1).
Carcinoma involves 3 mm of aggregate biopsy length 15 mm (20%).
Three of multiple core fragments are involved.

Am I overly worrying? Do they normally stage the cancer? Is there any significance to perineural invasion? Four cores involved? Percentages? Inflammation present?

TIA. I appreciate any input.

Anna