Gleason 6 (3+3) treatments

Frontline/PBS sometime back had the history of the Mayo Clinic was initially founded by a physician, then his two sons began the expansion. Yes, the theme of treatment is doctors receive their compensation regardless based on how many operations they perform. The concept is a team-based approach (emphasis added). For this reason, alone, Mayo is one of the best.

Medicine is all about money. It seems rather distasteful a physical would push one into surgery because of the economic benefits. But, this situation occurs to thousands of men yearly.

I’ve been told that Centers of Excellence like Mayo and Northwestern Medicine in Chicago where I receive treatment indeed pay fair salaries to physicians so they don’t have to sell their services to earn their keep. For my first go-round of prostate cancer, I went to a local community health system that I now recognize as having second class care. As I understand it and I could be wrong on this, urologists that performed radiation therapy or surgery were incentivized financially when they did those procedures. My initial urologist specialized in robotic surgery so that’s what he recommended. The second urologist specialized in brachytherapy and EBRT so that’s what he recommended. The team approach did not exist them, and to the best of my knowledge does not exist there now. Each of them trash talked the other’s procedures leaving me feel like I was the monkey in the middle. I believe financial considerations often came before patient care, which is why I now appreciate the differences in the comprehensive care that Mayo, Northwestern provide.

Very well said by offering "proof" of how those who practice a form of medicine will most always recommend "their" treatment options.

For those who cannot for many reasons utilize resources like the Mayo Clinic, the challenges of attaining the right decision is even or and issue. Afterall, it is about life!

I just returned from a consultation at the Sunnybrook Hospital , Oddette Cancer Center of Excellence in Toronto .
My Urologist at The Princess Hospital in Toronto , ranked in the Top 5 Cancer Teaching & Research Cancer Centers in the world , in consultation with the Sunnybrook Radiation Oncologist concluded, with the highest degree of certainty, to go with the Gleason 3 + 3 = 6 result not the G7.
They reviewed my MRI's , Biopsy Procedures and the pathology results .
Most importantly knowing the High Volume Expertise and reputation of the pathologiist who performed my 2nd Biopsy results , their decision was clear cut .
As we know all pathologists are not the same -- Nor do they have an associate check their work before issueing their report .

All this brings me to my concern about my local urologist. I went in a little over a year ago once my PSA was above 4.0. Thinking that if we caught it early I would be able to get focal treatments and try to avoid the side effects of either surgery or radiation.

He did a MRI that indicated a likelihood of cancer. When I went to his office he said... "probably nothing, I will see you in a year." No biopsy.

I have a strong family history of PC, small prostate, low testosterone, and a MRI that indicates probable cancer. The research says you add all this up and more than likely I have at least moderately aggressive cancer, if not aggressive.

Move forward to this year... PSA had increased again. He just wanted to do another MRI. I said no... I wanted a biopsy. The results were Gleason 7 (3+4). With moderately aggressive cancer on both sides of the prostate. When he called to tell me the results it was obvious he wanted to do surgery.

My question is... did he wait hoping that it would progress so he could do surgery and get paid more? Or was putting off the biopsy a legitimate medical decision? If we would have done the biopsy last year... would it have been on one side and I would have been eligible for focal treatment? I will never know now. And this bothers me.

CHANGE YOUR UROLOGIST .
Any Urologist who ignores an MRI is in my opinion is " A QUACK " .
If you live in the USA , I would consider consulting with a Personal Injury Lawyer who specialises in Medical Malpractice cases . You may have a strong case . The lawyer as you probably know takes these cases on a "Commission Base . It will not cost you a dime up front .
Finally . There are many Focal Therapy options for Gleason 3 +4 = 7 cases .
Good luck -- Be your own advocate . It's your health .

Have you educated yourself by purchasing : ?
Dr. Patrick Walsh's 5th Edition book " Guide to Surviving Prostate Cancer "
It gives new cancer patiients an indepth education in Testing , Gleason Scores and what they mean , Treatments radical Surgeries plus Focal Therapies and their side effects . And much , much more -- Money well spent .
Your Gleason 3 + 4 = 7 is considered " Favourable Intermediate Grade Cancer " which is good.
Gleason 4 + 3 = 7 is considered " Unfavourable " " " NOT GOOD.
In short , there is no need to rush out and get a treatment tomorrow and make a knee jerk decision you may regret . Digest the book , and checkout ALL YOUR OPTIONS -- AND YOU SELECT THE ONE SUITABLE FOR YOU & YOUR FAMILY .
Finally , as you will read everywhere on this forum . Pick an expert surgeon , with a history of performing a large volume of your selected treatment . You do not want to be the guinea pig for an intern in training .
p.s. What did your MRI show for the T Score and PI-RADS Score . They show on the MRI Report .

PI-RADS was a 3. I cant find the T score.

PI - RADS 3 Likely Gleason score 7 Intermediate Grade . A 3 + 4 = 7 or 4 + 3 = 7
See my reply Favourable Intermediate 3 + 4 = 7 .

Here are some things I suggest based upon my own experience:

1) Request a decipher test on the tissue from your biopsy. This is a step beyond the Gleason score and helps determine how aggressive your cancer is.

2) Give thought to getting a second opinion from a Cancer Center of Excellence. Here's a link:
https://www.cancer.gov/research/infrastructure/cancer-centers/find
3) If your tumor(s) are contained within the prostate, focal treatment is something to look in to. These treatments use a variety of ways to ablate (kill) the tumor(s) without removal or radiation. Look up things like HIFU, cryotherapy, Irreversible Electroporation (IRE), and others.
https://www.medicalnewstoday.com/articles/focal-therapy-for-prostate-cancer
My PSA score that got the urologist's attention was 4.25. A follow-up MRI indicated two tumors (PI-RADS was a 4), both contained within the prostate. My biopsy showed a Gleason score of 3+4=7 (intermediate risk) and my decipher results indicated low risk, making me a candidate for active surveillance or focal therapy. I chose focal treatment because one of the tumors was abutting the edge of the prostate. I had the IRE treatment in January 2024. After the treatment, I had some relatively mild incontinence which has mostly cleared up. I also had some blood in my urine for about six weeks after the treatment, but that has totally cleared up. My sexual function is unchanged from before the treatment.

My PSA last week was down to 1.95. The follow up multiparametric MRI (mpMRI), also last week, showed “post ablation changes of the prostate with no new recurrent tumor in the treatment area and no new suspicious lesions in the prostate”. My doctor said that later, if there is an indication that cancer has returned, I can consider an addition IRE treatment, removal or radiation.

Focal treatment is definitely not for everyone, but with the proper set of circumstances, it would be an alternative worth considering.