Dear Mohammad,
It is disconcerting to get a diagnosis of cancer, but you are taking the right step by seeking information. Here are some important points that apply to your description:
1. It is reasonable for you to be optimistic about your long-term prospects, and also reasonable that you have a good chance of avoiding therapy altogether or at least delaying it.
2. It appears you have a combination of infection/inflammation and prostate cancer that is likely the mild type.
3. The therapy suggested to you by the Indian doctor is one I am quite familiar with as a long-term veteran of “androgen deprivation therapy (ADT), also known as hormonal therapy and by some other names. The approach offered to you is reasonable, though I advocate a version that some doctors believe is superior, adding a third drug. In your case, if there is no stealthy cancer that is more aggressive than Gleason 3+3=6, there is a chance that therapy could be curative, and, even if not curative, could likely be used intermittently for many years, by which time better curative approaches are likely to be available.
4. Surgery is an option, but in recent years opinion in medical circles has shifted to avoid over treating cases that are mild, as yours appears to be.
Regarding optimism, patients diagnosed in the United States are now surviving cancer superbly well at the 5 and 10 year points – nearly 100% compared to age-matched mates, and exceptionally well at 15 years: 95% - the best of any major cancer, and many living well beyond 15 years. The unfortunate few who are pulling down the percentages usually have distant metastases when they are diagnosed, and that is almost certainly the extreme opposite of your case.
Regarding the possibility of infection/inflammation along with your cancer, the substantial drop in PSA after antibiotics suggests that some infection/inflammation is a strong possibility.
Regarding ADT as the first therapy used, even for mild cases, which is most unusual in the US but common and well researched in Japan, ADT appears to be able to kill Gleason grade 3 cancer, which is what you appear to have based on the biopsy: two grades of 3 combining for a score of 6. A 10 core biopsy is fairly thorough. I can refer you to some key research if you would like. Do you know how many cores were cancerous, and what the percentages of cancer were for each cancerous core? Do you know your PSA “density”: dividing PSA by the size of the prostate in cc? These additional important facts can help you navigate the therapy options, including one below called “active surveillance”.
I had a highly challenging case, but for the first thirteen years intermittent triple ADT (ADT3) was my only therapy, along with supportive medications and lifestyle tactics (aerobic and strength exercise, diet, nutrition, supplements, and limiting stress). You have two elements of this combination: Zoladex and Calutide. The third element is one of the two following drugs (US names): Avodart/dutasteride or Proscar/finasteride. The latter drugs function to almost completely eliminate conversion of testosterone into far more potent and dangerous dihydrotestosterone (DHT), a shift which we think makes the Calutide more effective as it does not then have to compete with DHT. The goal is to get your PSA down to 0.05 or lower, ideally down to less than 0.01. That is achievable for many of us, even for me with my miserable start (113). My doctors monitored testosterone and DHT as well as PSA. You want testosterone to drop to less than 20 ng/dL, and the DHT to drop to less than 0.05 ng/dL; if they do not, it indicates there may be a flaw in the delivery of medication or unusually rapid clearance of the drugs by the patient. Your PSA is dropping nicely after what seems to be something between one and two months on ADT; if you do not shortly get it to less than 0.05, going on the third drug would probably be wise. (That’s what I had to do to get my PSA to drop below about .6, where it was leveling off.)
However, even ADT in the coming months/years may not be necessary for you. Worldwide research published from 2002 through this year has demonstrated the safety and high effectiveness of a technique known as “active surveillance” (AS) for cases with characteristics like yours. The idea is to monitor the cancer to guard against a stealthy cancer that is more aggressive than virtually all Gleason 3+3=6 cancer, and defer major therapy until – if ever – more aggressive cancer is detected. AS research has proven it is extremely rare for a monitored, suitable case to ever suddenly become so aggressive that it cannot be treated with the aim to cure with surgery or radiation. Almost always, the minority of stealthy aggressive cases that are detected by monitoring can be treated in time to cure, with results virtually identical to results of patients treated shortly after diagnosis. In the meantime – while on active surveillance and deferring therapy – you do not have the side effects of major treatment, and you are gaining time for technology to keep improving, which it is doing at an impressive pace. I suspect there are doctors in Bangladesh that can do active surveillance with you, almost surely in India also. Singapore is such a location of medical excellence that it is highly likely to have such doctors.
Good luck to you!
Requesting Opinion on My Prostate Cancer from Experienced People 
