Gleason7(3+4) - treatment options recommendation

Hey Phil great info and exactly what I was looking for! How long has it been since your prostatectomy? I understand the ED can improve over time, sometimes 2-3 years later. Did you have the surgery at Mayo? Where was the Cyberknife done?

Hi Phil , your surgery was 5 years ago ? ....did your PSA go to Zero after surgery , Mine did not , it hung around 0.07 , then started to rise slowly , so 1 year ago I had EBRT . At first, it bounced downwards and then hung around 0.14 for the longest time. That's the PSA range that I went into the radiation clinic at . after about 6 to 7 months, it started to come down. First at 0.072 and now at 0.056. So expect a delay . I know some guys after surgery at five and six and 10 years still at 0.008 which is the unreadable mark in Canada . After 22 sessions and 1 year I think things are good ! So you have been to Vancouver ? I am from there . Moved here 5 years ago ,roughly the same time I was diagnosed with PC . Vanc city is getting expensive and overrun with immigration.... Vancouver Island still the paradise it always has been , BUT getting busier . You should have seen it while here . One of the world's marvels ! Very unique climate and forest . We have wild Orchids here ! Salmon galore , Old Growth , Wild apple trees, and the climate is different than the mainland 40-50% less rain in winter than Vancouver or Seattle . Thank God ! My local Costco is my gauge of how our population is 🙂 . Fishing and hunting is still very good and easy ! Cod fishing Super easy for a 15-20 lb Ling Cod if you like those ! As the salmon run comes back starting at the end of Sept , you have to watch for bears too by the creeks . Yes , Gods country for sure ....BUT our liberal government is horrible ( I wont get into what this guy has done to our country ! ) . What state are you from ? My boy played NCAA Div 1 on scholarship - been to so many states , maybe yours (?) . yes no worries about the Constipation , the EBRT therapy will cure that ! HA!!! . Best of the day my friend . James on Vancouver Island .

After biopsy, I was declared a 3+4 Gleason. Had surgery and Gleason was actually 4+3. Active surveillance is not always a good answer for 3+4

In my case active surveillance is not an option because I also have a lesion currently in EPE1(extra prostatic extension) and definitely need treatment. Still leaning on NS RALP
pending consultation for R/O. My Urologist recommendation for prostatectomy still remains same

I totally agree .
ALL cases are different - that's why I recommend listening to the medical experts advice . I have an associate in Toronto, Gleason 3 + 4 = 7 , who has been on AS for 7 years . He just turned 60 and is reviewing his options for treatment while he is still fit and relatively ( except for the cancer ) healthy .
At this juncture , in consultations with his Tumor Board at the Princess Margaret Hospital , ranked in the top 5 centers of excellence in the world . He has decided to continue on AS with stricter monotoring .
Finally , as you are probably aware . It's not unusual for a Biopsy following a RP or death , to have a Gleason score uprated . It's for this reason I further highly recommend someone to have a 2nd or 3rd opinion of their Biopsy pathology results .
In my case my 1st Biopsy was negative . Not being satisfied as the results were in conflict with my MRI T2 PI- RADS 5 results . I had a 2nd 16 core Biopsy - the result 6 cores in the target area were Gleason 3 + 3 = 6 ( All 5 cores from my 1st biopsy in the target area were negative -- Go figure ) Once again being conflicted I had a 2nd opinion on my G6 pathology results .
This time they came back - All 6 cores Gleason 3 + 4 = 7 .
Now I have cores from the target area , following my Transperineal MRI Fusion Biopsy . Negative -- Gleason 6 and now Gleason 7 . Put them in a hat and draw one out .
As Patrick Walsh stressed in his book " Guide to Surviving Prostate Cancer " -- Never feel embarrassed about getting a 2nd or 3 rd opinion on not only your biopsy results but your recommended treatment options and final selection -- Your life may depend on it .

You may wish to discuss a less radical approach with your Tumor Board '
HDR Monotherapy Brachytherapy - 2 sessions 2 weeks apart . or SBRT . The latter is 5 treatments Mon - Wed Fri and Mon Wed the following week . A fast outpatient recovery .

@pmclarksr -- I saw your question to @heavyphil and thought I'd weigh in as well since I had bilateral NS RALP at Mayo Phoenix in late 06/2024. I'm 70, 5'11" 187 lbs reasonably fit (not excessively so). Recovery from surgery has been excellent. The week of the catheter was unpleasant, but pretty much as described.
Pain after surgery never exceeded 2 on a scale of 10, although I strictly followed surgeons advice to take OTC pain meds (Tylenol and ibuprophen). Once the catheter came out I had Depends and pads ready, but never had any incontinence except a few accidents as things do feel different. I stopped using the Depends after a day or two, and stopped bothering with pads by about day 4 post catheter. I do still sleep with a pad under the sheet, but haven't had 1 accident during sleep. As I said things do feel a bit different, but every week I feel more confident. No leakage lifting weights at the gym, but if I try to fart I will have some leakage (which I attribute to relaxing the muscles to fart basicly allows the leakage). I did do kegals about a month before surgery and resumed them after surgery when allowed. I have no idea if they helped, although I would guess they probably did. Now on to sexual function. I don't have normal sexual function, and I think that'll take longer to recover (if it does). I am taking Viagra nightly as part of penile rehab to help blood flow. I started trying to have intercourse about 4 weeks after the catheter came out. When I try to have intercourse, I do get a response but it's far from satisfactory. I have seen improvement, but it's too early to know how much sexual function I'll recover. At this point I'm getting maybe 65% firmness (as compared to before surgery) and just barely adequate to allow penetration. My wife is very supportive and patient with me, and a major factor in the limited success I've had so far. I have had 3 climaxes during intercourse, and of course they're dry climaxes and frankly less satisfying than before surgery. But I'm encouraged I was able to climax at all. To be fair, before surgery I had needed Viagra so I wasn't starting from a pristine state. Progress is slow but so far I am still making progress. If I don't recover my sexual function to a satisfactory level, then there's a range of treatments I've yet to explore. As far as everything else (appetite, sleeping, general feeling of health), overall I feel great; just like before surgery. My wife and I are hikers and spend a lot of time together, and other than my reduced sexual performance, we can still enjoy ALL our other activities. For me this has been a big plus. On a positive note, without the prostate my urine flow is great; like I'm 20 years younger. After surgery, the pathology report on the prostate found both Cribiform and IDC in the prostate, which is bad. When I read that I was pretty happy I had the surgery . The margins were clean and indications are they got it all, but time will tell. At this point (almost 9 weeks), I'm pretty happy with my decision to have the surgery but again, time will tell. Of course, every case is different and everybody responds differently to treatments, so I have no idea what's best for anyone else. I wish you all the best in figuring out how you should proceed. If there's anything I didn't cover that you'd like more information about, just ask. I have no reservations sharing anything about my experience.

Speak to your urologist about Trimix. It will allow you to get a firm erection. You have to inject your penis with the very thin needle every time you use it, but everyone I know that has used it says that doesn’t hurt at all, and the erection lasts for a while . You do have to go to the doctors office to find out how to inject it.

@pmclarksr -- Thank you taking the time to make me aware of Trimix. I really appreciate your comment. I have read up on it (thanks to this blog) and I intend to try it when and if the time comes. Since I'm so soon out of surgery and based on my reading, here's my tentative "plan". 1st -- at my 3 month visit with the surgeon I'll ask which of the urologists at Mayo Phoenix are proficient in penile rehab and schedule a consult to baseline my progress and get his advice on when I should proceed beyond the Viagra (which I was already using before the surgery). I don't know what's a reasonable time to wait, but I'm sure he will. 2nd -- I intend to follow his advice, but what I want to discuss with him is what he thinks about the following: once I've waited long enough and if the Viagra isn't providing a satisfactory experience, then I'd like to progress through trying the other "pills", such as Cialis and Levitra and Stendra to see if one of them works better (for me) than Viagra. If they all fail as well, then next up on my list to discuss with the doctor is the Trimix topical cream. Then after that maybe the Trimix gel or pellet. I'd like to get to the needle only if the other approaches don't work first. It's early enough I'm still hoping I'll get a satisfactory response from Viagra once I've recovered more. Of course, this is what I came up with based on my reading. Since I'm not a medical professional nor have any experience in this, I really plan to rely on the advice from whoever is the penile rehabilitation expert at Mayo Phoenix. In a nutshell, that's my "plan". Let me know if you think I'm missing something or just thinking about it wrong. Again, thanks again for making sure I was aware of Trimix. I really do appreciate it.

No, I had my surgery here in NY by Dr David Samadi. My friend had Cyberknife at Sloan Kettering.
Just go with an experienced provider -Mayo, Sloan, Hopkins, Cleveland Clinic, MD Anderson, etc and you won’t go wrong.