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

Posted by paulg24 @paulg24, Nov 16 2:26pm

I am 72, recently diagnosed with with two localized tumors, one at the right apex, another at the right base. I have a girlfriend and we have an active sex life. I've been to two centers of excellence and neither wants to do any type of focal treatment. So, I'm considering going on active surveillance, and if I die earlier death than I might otherwise experience with treatment, then so be it. I have no children or living family. I'm what the media referred to a few years ago as an "elder orphan," so my quality of life is more important to me than living a long time.
Would very much appreciate any thoughts or insights.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

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.

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@bigtoe

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!!!

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

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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.

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@bigtoe

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!!!

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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 .

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@ranger44

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.

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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?

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@jeffmarc

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.

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I am 4+3 and on active surveillance. I had first biopsy 2/23, and second biopsy 9/24. There was no change - very small amount of cancer in one core. I have a psa test every 3 months. My psa has increased from 6.8 in feb 2023 to 7.3 last month. The oncologists were the ones that recommended AS - all of the urologists I have seen disagreed

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@clandeboye1

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 .

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I agree. I talked to 7 doctors after my diagnosis and not one of them would even consider AS for my Gleason 7 (4+3).

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You may be a candidate for a number of Focal Treatments .

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@ranger44

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.

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I also was a Gleason 7 (4+3) I did a ton of research (talked with 7 doctors) and like you did not want to have any quality of life issues. I chose Tulsa Pro at Mayo in July. My PSA went from 8.6 to 0.68. 45 cc prostate. I have had zero side effects. Only had a catheter for two days. The catheter really is not a big deal. I had zero pain and didn’t even take a Tylenol.

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@ranger44

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.

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I was first diagnosed with prostate cancer in 2018. I was in active surveillance until 2024 when my PSA started to raise I went for an MRI followed by a biopsy. It showed that my cancer was growing from Gleason 6 to Gleason 7 (3+4). I decided to go for surgery to remove it. Is going to be 9 months I am perfectly fine. Only on side effect but my erection is coming back never had a problem with urine leakage I happy that I chose that course of treatment.

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