Gleason7(3+4) - treatment options recommendation

It was a 3+3 on active surveillance.

At your age, you could probably avoid ADT because you are only a 3+4. Usually, they want to put you on six months of ADT to prevent the cancer from coming back soon, but that is up to your doctor.

Where are you going for treatment? If it is a Mayo clinic then you are getting the best advice. A urologist does surgery so they want to do surgery? You could consult with an oncologist to see what they feel your best options are. If you do that, you want A Genito Urinary Oncologist, since they specialize in prostate cancer, unlike a medical oncologist.

Be aware that at your age surgery should be totally out of the question. I would really question any urologist that would recommend that.

If your Decipher score is low you do NOT need ADT - my 73 yr old friend just had SBRT with NO ADT at Sloan.

I have consulted with a Radiation Oncologist , at my request , to investigate Monotherapy HDR Brachytherapy - 2 Treatments 2 weeks apart , plus Monotherapy SBRT 5 treatments . I have also consulted on the NanoKnife procedure which is used worldwide . ( to a lesser extent in the USA . ) I am working with two Centers of Excellence in Toronto - The Princess Margaret Hospital ranked as 5th in the world regarding Research & Treatment and Sunnybrook Hospital , also a world leader in cancer research & treatment .
I am proactive with regards to events in my life , and more so with regards to my health . I lived for 22 yyears in the USA and am well aquainted with their centers of excellence .
I am also a big fan of Dr. Patrick Walsh's book : " Guide to Surviving Prostate Cancer " .
Additionally , I have consulted , via telephone with world leaders in the treatment of prostate cancer , in the USA , Australia, U.K. Germany and Canada . As an engineer , I am a gluten for learning .
Thanks for your sage responses .

Thanks - I fully understand the situation and agree 100 % with your comment .

Thanks for your sage advice .

Sounds like you really have it under control. Some of the best options I’ve seen for people in Canada. Wish you the best in treatment results.

8 yrs ago I had focal therapy for PSA at 4.2. After FT PSA went to 1.8. Each year the PSA has increased by @.5. Now it is 4.2 again. MRI does not show reoccurrence or new cancer. What should be my next move if any? I’m 72 years old.

@watsohj
A lot of possibilities while you monitor your PSA that have come about in the last eight years. These newer non invasive tests include ExoDx urine test, and PSE blood tests. These are used to help in determination of going forward with a biopsy in light of the MRI showing nothing. In your case without any targeted lesion to sample would be a full on grid. I don’t know if part of your PSA test is the free PSA percentage. It would be helpful to add some of your original diagnostic’s from eight years ago, like your MRI and biopsy results. FT is known to just kick the can down the road. You are still at a good age if something is brewing to have many options. I would continue to clearly monitor. What does your Doctor say?

@watsohj
You should be having a PSMA PET scan. The MRI may not find anything, but somethings creating that PSA.

Frequently the MRI does not show cancer, which is very aggressive inside the prostate. The only way to find it is to do a biopsy that covers a lot of the area left of the prostate, Or do a prostatectomy. I wouldn’t do anything until the PET scan is done.

Hopefully you’re not in Canada and can get this done since your PSA is so high. It is guaranteed to find whatever’s causing this problem..

It is possible that during focal therapy they only removed a small portion of your prostate. In that case rising to 4.2 may be just normal for your age. I’d want the pet scan though to prove it is normal.