3+3 - others' experiences and questions I should ask doc?

Yes. Someone should not base their decision on my reaction. Your Dr is probably right. I was 68 no other issues. High Cholesterol my entire life. I was allergic to statins. I had a knee replacement at 52. No issues with ED. At the time married 46 years. Happy. We Just retired. 6 months after surgery my wife was DX with GBM. She is on hospice now. One year later I had carotid surgery to remove a blocked artery.(just avoided a stroke) At the same time got an autoimmune disease called PMR. Your exactly right. Your Dr was right. There are no guarantees. I have not had a sexual partner. So zero stimulation. I do not even try to stimulate myself. Incontinence is a PIA but manageable. I have had one UTI. But the best I could do was just take them one at time. Just like what I have coming. I have never been with another woman. Doesnt even sound appealing with no erection and dripping pee. I go to the gym everyday. I keep my testosterone level at about 650 with a cream. (questionable). Old age isnt for sissies is right. I can tell you that any decision you make is probably not the path life will take you anyway.

Thanks for the reply. My dad had prostate cancer at age 58 with RP and hormone therapy.

Gleason 6 (3+3) initially with PSA of 6 at age 60. Decipher of .26, which is low/very low risk. Decided to go with AS. One year later, Gleason 7 (3+4) with a new lesion and possible extracapsular spread per biopsy, PSA still 6. Had RALP. Pathology showed cribriform glands and a positive surgical margin. Appears that there was no spread so far. No real incontinence, just a few drops with exertion. Too soon to know about ED. But risk of recurrence is now double because of the positive surgical margin. Glad to have it gone, at least for now. Surgery and catheter were far easier than anticipated. Hindsight is 20/20 so I wish I had RALP when diagnosed. Now the road is likely harder. If you go with RALP, find a very high volume surgeon. Good luck to you on this journey.

@happydappy and if your dad had it, that is even more reason to have a discussion with your doctor. You also might want to ask about the myrisk genetic test if you have children, male and female, as there may be a gene that has been passed on.

Thanks for sharing your experiences and hope things stay stable for you for the long term. I assume they found the 3+4 on a follow up biopsy. Can you tell me what led to a new biopsy if PSA remained stable?

The urology oncologist I see is world renowned for robot assisted surgeries and focal therapies. Off to see him now and will see what he says. I appreciate your suggestions and definitely will ask about genetic testing.

First of all, welcome to the forum and best wishes for success on wherever your journey with PCA takes you. I’m not a doctor, just a two time PCa patient that was originally diagnosed incorrectly with Gleason 6, (3+3) so please don’t take my comments as medical advice. I participate on this form to inform other newly diagnosed patients about the need for the best biopsy available.

From everything I’ve read, true Gleason 6 PCa won’t develop into more aggressive cancer and can be monitored for a number of years using active surveillance. The million dollar question however is: “Can a biopsy that resulted in a Gleason 6 score be trusted to be accurate without the risk that it’s actually more serious higher grade cancer? As I understand it the gold standard for prostate biopsies today is an MRI guided fusion biopsy. Is that what you received? I’ve read that the most common prostate biopsy given, the 12 core random biopsy has historically missed up to 30% of significant adenocarcinoma resulting in under-diagnosis and under-treatment of serious disease. My insurance would not approve an MRI guided fusion biopsy and I settled for the best biopsy I could, which was a grid type perineal biopsy that attempted to sample the area at the anterior apex where a 3-Tesla MRI showed a significant PIRADS 4 lesion. We know now that the sample missed the core of the lesion and five different physicians believe that if it had been sampled appropriately, I would’ve had at least a Gleason 7 (4+3) score if not a Gleason 8 score (4 + 4) and my course of treatment should’ve been different than focal Brachytherapy that I went with. My life is forever changed as I have Stage 3 oligometastic PCa.
I had salvage RP in January, started 2 years of Orgovyx and Zytiga ADT in April and am currently in process of receiving 33 sessions of IMRT to the pelvic lymph node basin. Surviving cancer is my number one priority and helping other men avoid the same challenge ranks high with my other priorities.

You’ve got one shot to get this right the first time and I recommend that you pay attention to making certain that you can get the best biopsy possible to avoid my fate.

I’m new to this so my journey has only begun. Two tumors confined to the prostate and each 3+4. They are in a position that HIFU can deal with. Genetic testing didn’t find the cells to be notably aggressive and I showed no genetic anomalies indicating increased risk in spite of a family history of prostate and breast cancer. My prostate is a bit too large for the HIFU right no so we’re opting for 6 weeks of Orogvyx and an ultrasound to see if it’s shrunk to surgical size, if so, the HIFU will be scheduled. I have issues with restricted stream and not emptying my bladder so something had to be done anyway to relieve that, hopefully this will accomplish two things. I have a bad history of "wait and see" with a couple other diseases and things happened quickly, so I want to treat the PC now while it’s confined and eligible for HIFU.

This is a helpful post. I've got 2 path reports. One says 3+4 and the other says 3+3. My PSA is 2.2. My dad was 65 when he was diagnosed with Stage 4 prostate cancer. I turned 54 last month and don't like the sound of the side effects, but also prefer to live. The Jacksonville Mayo dr I visited seems rather arrogant. The radiologist I visited seems hell-bent on selling radiology. I think I'm going with RP, but I wish I weren't.

I have seen on here many that have had LARP and are having no issues. If you dont like your surgeon thats probably a good clue. I didnt like mine. I agree with everyone on here that says your looking for the best. 1000's of surgeries in a quality facility. statistics are 85% with no issues. I ended up in the 15% on both. I get your feeling. 54 is young. Maybe its not the best decision. It was the one I had to make. I wish I hadnt got cancer as well but....

Does anyone know whether the Mayo perineal biopsies done in Rochester are the MRI guided, or just ramdom sampled based upon MRI results. I'm having difficulty understanding whether I had an MRI guided biopsy there or not.