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

I was upgraded to 4+3 from apparent 3+4 after a second MRI and subsequent biopsy. Unfortunately, as you have discovered, that really changed the medical recommendations. I am now 3+ years out from initial PSA out of range and 2.7 years out from RALP (surgery.) I know a lot now I didn't know then. I don't think they steered me wrong.

At four months of hormones therapy was to prevent you from having a reoccurrence. You’re rolling the dice, not doing it..

The more I read on this forum, the more I am leaning towards no treatment of ANY KIND. Radical Prostatectomy is major, life altering surgery with serious life changing quality of life issues, Radiation almost as bad, and hormones and ADT, good God, destroy the man just to keep him alive. I am 70 years old my PSA went from 4.47 to 6.44 in October 2023, I had 4K score test and MRI fusion perineal biopsy at Mayo, and was diagnosed February 2nd 2024 with Gleason 4+3= 7 w/ 70% in 6 of 23 cores, 3 cores had Gleason 3+4=7 w/ 40% I had Pirads 4 pm MRI w/ 12 mm lesion ( volume .42cc) my prostate is 50.4 cc so low volume tumor, I had PSMA PET showing nothing outside the prostate, and my Decipher score was 0.38 Low Risk of Metastasis, so it showed 3.4% risk of met at 10 years and 3.4% risk of mortality at 15 years, average lifespan for men is 82 or less. Granted, that is with standard of care treatment. Risk with no treatment of any king increases your risk 100% so 6.8% big deal, I'll take those odds against ruining my life, I don't even want to have a catheter. I have done tons of research on all forms of treatment, including focal therapy, Hifu, Brachytherapy, Tulsa Pro, Cryotherapy, and they all have side effects. I have also done major research on the Ketogenic diet, intermittent fasting, and foods proven to fight prostste cancer, watched many You Tube videos with Dr. Thomas Seyfreid, Dr. William Li ( food as medecine) Dr. Ken Berry and many others. Glucose feeds the cancer cells, so eliminate all sugar of any kind, vigorous exercise reduces Glutamine which is the other cancer cell fuel, I went on this and in one month, lost 13 pounds, feel great, PSA is now down to 5.12, yes it is an extreme regiment and diet for this former carb lover, and food lover, but I'm willing to sacrifice that rather than take a chance of even 10% of lifelong ED or Incontinence and having to wear a pad or diaper, also some treatments like radiation can damage the Rectum and affect your bowels, I don't care if that's a 2% chance, I'm not taking it. At some point, quality of life is more important to me than seeing how long I can survive. Prostate Cancer is big business, billions of dollars and the medical industrial complex is geared to "TREAT", surgery, radiation, emasculating drugs, you name it, not many doctors recommend diet & exercise to fight low or mid grade cancer. The current treatments seem so primitive, they just cut out your prostate and take 2 sections of Urethra, shortening your penis 1.5 inches in addition to a good chance of impotence, sounds like a treatment from the middle ages. I watched my Dad go thru it, and even if it metastasizes after 10 years, it's not the end of the world, and very few men actually die from prostate cancer, look up the ProtecT study in the UK same survival rate at 15 years for intermediate PCa 1/3 of men RP, 1/3 of men Radiation and 1/3 no treatment just Active Surveillance. Think very hard before having any treatment, there is no rush, even the most aggressive form take a while to spread. So now I am 71 and on Active surveillance, will just check my PSA every 3-6 months, In the meantime I have had 10 great months, no symptoms of any kind, I will let nature take her course, I would like to be a case study for NO Treatment and see how it plays out, I've had a great life so far at 71, I'm more afraid of living with side effects that would, for me ruin a great life. Everyone has to make their own decisions, and I am not recommending my choice, I just know there has to be some others out there in their 70's or 80's that feel the same.

Interesting Gleason result on your 2nd Biopsy . Follow my tale .
Biopsy # 1 5 Cores in the Transperineal MRI Fusion Biopsy TARGET area -- ALL NEGATIVE .
This conflicted with my PI-RADS 5 . probability of cancer .
Biopsy # 2 15 Cores . 6 in the TARGET area ALL Gleason 6 . ( The remaining negative )
2nd Opinion ALL 6 -- Upgraded to Gleason 3 + 4 = 7
3rd Opinion 4 were Gleason 6 2 were Gleason 3 + 4 = 7
Take your pick . I have been on Active Surveillance for 1 year . My recent , 3T year-over-year , MRI showed no change . Yet my PSA has gone up from 7.3 in Dec 2023 to 10.0 in October 2024 .
Given I have been on Dutasteride for over 4 years I have to double my "Lab PSA" . Therefore my true PSA today is 20.0 . I am researching Focal Therapy , perhaps NanoKnife . I am 85 plus years old .

Thanks for your detailed post!

You’re the first I’ve read (in detail), diagnosed with 4+3, who chose what I like to call “aggressive AS”!

I was beginning to think I’d never see another with clinical-genomic indicators, past mine, who decided to take the AS road less traveled…

Regarding your comments about the risks of significant quality of life diminishing side effects of all currently available treatments…I get it!

In fact, see this MCPCa thread regarding a new large, long term study that quantifies the Long-Term Adverse Effects and Complications After Prostate Cancer Treatment….in some respects it’s even worse than your description AND in many cases these probabilities are not being told to those who want to jump quickly into treatment (especially those with low and favorable risk PCa).
https://connect.mayoclinic.org/discussion/long-term-adverse-effects-and-complications-after-treatment/?pg=1#comment-1174903
I’m with you…I don’t recommend men with Gleason 7 chose AS…there’s so many personal values involved in one’s decision.

Each man must make his own decision…and live with the consequences…the good, the bad and the ugly.

I am curious about one thing. Is the any future test result, or level of PCa symptom(s), that would push you into some form of treatment?