Is anyone with Gleason 4+3=7 trying active surveillance?

Did your biopsy Mention if you had intraductal or cribriform. In that case if you do nothing you are not going to live long without serious issues. Dying of prostate cancer is extremely painful. My father had his teeth ground down and capped without Novacane. He came home and ate dinner with us after that. While he was dying, he was on so much morphine he really couldn’t talk to anybody..

Most people keep the ability to have an erection after radiation. SBRT radiation works for most people, MRIdian is even better. There are many other non-radiation treatments like HIFU, cryotherapy, TULSA-PRO or more that can allow you to keep your erection. Have you looked into all of them.

I’ve never heard of a person with 4+3 taking actor surveillance as a choice.

I agree with @jeffmarc. 4+3 is typically beyond "active surveillance". I had ARC targeted beam radiation to knock out some specific tumors. Worked fine with no problematic side effects. Everyone's situation is different. It's best to die with, rather than from prostate cancer. The lack of achieving an erection is the least of your problems.

On boards specific to active surveillance, you may find someone but I would be surprised if anyone here is choosing surveillance for a 4+3.

You do roll the dice with radiation and ED but if your baseline is good the odds go up in your favor. I am a year and a half out from proton beam therapy and erections are better than before. Unsure as to why but it is what it is and I am not complaining. I have lost about 10 pounds so that may have helped.

I do get where you are coming from but the cancer may begin affecting your erections well before you feel unwell and years before you die. Still, your body, your life, your choice. Wish you the best.

Sorry to hear you had to joined our ranks; but you’ve come to a great place to get support and information from well informed PCa “rank and file”.

I’ve been on active surveillance (AS) for 13 months since being diagnosed with low volume 3+4 and a Decipher score of 0.22 (details in my profile). I’m 68 y/o.

I think I’m probably as close as a man can come to the “continental divide”….where the generals of the PCa army would still be grudging willing to allow one “leave” to pursue AS.

I was also fortunate enough to receive a “stable to potentially regressive” report on my 12 months following-up mpMRI, so I’ve been told I can “carry on solider”…regarding AS.

Here’s a few things to consider, from my POV:

1) How many cores have cancer and what is the volume of cancer in those cores and particularly the volume of pattern 4?

2) What’s your PSA, PSA density and PSA velocity (doubling time)?

3) Get a Decipher test, with Gleason 7 one should only even consider AS if one is in the “low risk” category (< 0.40).

4) Get a 2nd opinion on the pathology of your biopsy.

5) Get a PMSA PET scan.

These things will help you understand the severity of your PCa.

I’m a huge advocate for AS; however, if my Gleason score were to advance to 4+3 in a future biopsy….which I will have in the next year or two…I’d be heading to treatment.

At this point, I’d choose MRI guided stereotactic body radiation therapy (SBRT) delivered with MRIdian…it’s “associated with better patient-reported quality of life”.
https://www.urologytimes.com/view/mri-guided-sbrt-shows-superiority-to-ct-guided-sbrt-in-localized-prostate-cancer

You are rollling the dice on Active Surveillance . I know breathing is not living -- But this is where you are heading
I recommend you educate yourself real fast on several of your less evasive options . I have one .
You and your girlfriend will reflect on your decision and conclude it was the best decision you BOTH made in your lives .
Good luck .

Quite the cryptic reply clandboye. I've spend hundreds of hours educating myself on all the different options. What is your selected evasive option?

A friend of my passed away last month. He chose AS and died at home. Cancer is not always predictable; therefore, it’s a gamble if you don’t do anything, except enjoy your current life style.
Good luck.

I would check with Mayo Clinic on Tulsa Pro. I was Gleason 7 (4+3). PSA 8.6 prior and now 0.68 three months out. Sex life restarted one week after procedure and no issues. Mayo can review all your current records remotely and let you know if you’re a candidate. My story below:
https://connect.mayoclinic.org/discussion/tulsa-pro-experience-mayo-clinic-mn-july-2024/

I'm 67 was diagnosed 4 days after my 65 birthday gleason 6 psa 6.2, months later after pet scan and mri they took another biopsy once they confirmed the exact location of my two spots, gleason scored went up to 7 (4 + 3) I did active surveillance for over 18 months , psa stayed around 6.2. I lost my father to prostate cancer 40 years ago and it was a terrible way to die so I finally decided to seek treatment. went to mayo Rochester two months ago and received Proton Radiation 5 treatments, declined the 4 months hormone therapy they suggested. Have to say I'm very happy with the results so far, time will tell. Psa check in 6 months. Can still get up to bat but started to take 10mg of tadalafil to hit a home run. Fyi my cancer was only detected on my prostate. Good Luck To All!!!

@paulg24 I had a 3+4 and was treated with the Mridian built in MRI radiation machine with 5 hypo fractional treatments. No doctor will be able to tell you that your specific body's tumor is going to grow at a specific rate in a specific period of time. Better to be treated early than hope that your additional testing will be timely. Once the cancer goes outside your prostate, treatment gets more complicated. If you do radiation, pick a machine that has built in mri as the mirage randomized trial showed this made a difference with a number of side effects and your exposed healthy tissue is less. I had some minor urinary side effects for a short period of time but was sexually capable pretty quickly. The only change that I saw in that regard was less semen than in the past. By the way, I had spaceoar inserted as well.