Gleason7(3+4) - treatment options recommendation

if you were a patient with San Francisco’s University of California prostate cancer group they would probably recommend radiation with a 3+4 Gleason . Have you considered getting an outside opinion?

Mark C. Scholz, MD, serves as medical director of Prostate Oncology Specialists Inc. in Marina del Rey, CA, He is one of the top people in the country for treating people with prostate cancer. He would be a great source for a second opinion.

If you want to check up on him go to YouTube and look up the PCRI conferences. He always gives some really good talks about treatment.

Surgery frequently causes you to lose the ability to have an erection. With radiation you don’t normally have that issue. With a Trimix injection you can probably work around that even if you have surgery.

Radiation has replaced surgery for most people these days. You should look into the other option.

Thank you @jeffmarc I’ll check this out. I had initially requested surgery for Oct 30 but that was with understanding that eventually I’ll go with surgery

Welcome to our unlucky club of guys with PC. I'm not a medical professional, and nor do I have any special expertise, and I certainly don't know which treatment option will be best for you. That said, I'm 70 and in otherwise good health when I was diagnosed 3/30/24 with 3+4=7. My best piece of advice is to go to a recognized "cancer center of excellence", which with Mayo clinic you're already doing that. Also, I'd strongly recommend the latest edition of Dr. Patrick Walsh's Guide to Surviving Prostate Cancer Paperback – (last I looked October 3, 2023 was the latest edition). It's on Amazon and it's the best $20 I ever spent. It really helped educate me on some key points in my decision making. At this point, probably the biggest thing is educating yourself. Whatever treatment option you choose, things may not work out as you hoped. So being at peace with your decision will really be integral to your peace of mind going forward. That said, another key piece of information will be how aggressive your cancer is and how widespread in the prostate. The results of a decipher test for aggressiveness coupled with the fusion MRI biopsy results giving an indication of how dispersed your PC is should help guide you to what's most likely to be the most effective treatment. In my case, for a variety of reasons my wife and I felt NS RALP surgery was the best option for me and that's what I did in late June 2024 at Mayo Phoenix. So far the results have exceeded my expectations as the recovery has been remarkably low pain and quicker than I imagined. Also, the pathology of the prostate found both Cribiform and IDC (not good) so I was glad I went with surgery. As you research which treatment is best for you, be sure to ask your potential providers specifically about incontinence, ED, cancer reoccurrence, long term survival, and other major aspects/side effects of the major treatment options you'll be considering. When I did that I was surprised that for my specific case with
NS RALP the numbers for not having incontinence and ED were more favorable that I thought they would be. Long term survival and quality of life were also factors high on my list. Best wishes on educating yourself and figuring out which treatment option will be best for you.

@manojsmishra
surgery may be your best choice, but you should at least get an opinion from a Radiation Oncologist or two.

Thank you for the time you took to explain in detail. So far I’m also leaning in NS RALP and with the trust I have with Mayo
ED, urinary issue such as passing on uncontrollably in work is my worry but my doctor seems positive it will improve. That plus elimination recurrence(hopefully) are in my mind

Thanks @gently . That’s where I’m leaning but ED and incontinence are still concern

You wrote “ Radiation has replaced surgery for most people these days. You should look into the other option.” And then suggested that he contact Dr. Mark Sholz in California.

You’ve totally dismissed Mayo Clinic as a center of excellence. Do you honestly think that the doctors specializing in treatment of prostate cancer probably at Mayo are second rate compared to other providers? Mayo sets the highest standard of care.

Stop spreading misinformation that more patients are receiving radiation as their primary treatment. Misinformation is offensive to those of us who are fighting aggressive disease and have gone through surgery after receiving that recommendation from a tumor board at a Center of Excellence.

If you want to share that you received radiation as primary treatment and that your PSA indicates cure please do so to help other men. Don’t give medical advice.

Prostate cancer is a complex disease and treatment is not a one size fits all solution. You’re not a medical expert and need to stop recommending treatment on this forum.

@manojsmishra
Which Mayo are you at? I got my MRI and biopsies at Mayo Jacksonville. Surgery was only propose as an option along with choosing radiation. Where you not offered both treatments?

Everyone is different and will respond different to radiation treatments. Some will have noted side affects and some very little or none. I had minor side affects that went slowly away. None of them changed my lifestyle in any way.
You mentioned surgery. The surgery is major not minor and does have a lot of side affects but again some do very well and some do not after surgery. This is normal with any surgeries.

My suggestion: Have your R/O offered the following tests? Decipher, PSMA, bone scans. They determine if your cancer is agressive (Decipher) and gives a risk level. PSMA shows if cancer has spread beyond prostrate. Bone Scans show if in bones.

If all those come back negative and low or even itermediate risks radiation is a very good option. This comes from Mayo R/O, UFHPTI R/O and my Mayo PCP. Not my personal opinon. But this was for me.

I had the same test results you had. 3+4=7 and 2. I was told surgery was option and gave me all the pros and cons. Radiation with hormone treatments pros and cons. Radiation only pros and cons. Then I had all the above test done and what the R/Os recommended was radiation NO hormome treatments.

My 3.75 at time of treatments is now .44 a year after treatments ended and I HAVE NO side affects remaining. I reached below 1 on my first 3 month after treatments that was goal of R/O. Now I have my PSA check every 3 months.

I wish you luck but really do some research get second opinions. Get the other test that will help guide you and your R/O or urologist recommend the best treatment for you.

Hi @jc76
I have been given option for focal as well as radiation therapy at Mayo Phoenix. I do have appointment in them.
In my case I do have a 1.2cm lesion which is g7(3+4) and mri is stating that it is in epe1 . But that did not seem to concern my oncologist urologist who will eventually perform my surgery if I choose to do so. I’ll discuss with R/O about it . With radiation
Were you told about its short/long term effects?

Also my psa was 5.14 when i did yearly exam this April that lead to being referred to urology and subsequent test and diagnosis