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

Posted by paulg24 @paulg24, Nov 16, 2024

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.

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I have 3+4=7 my urologist said it less then 2% of 4 in one core 25% of 3 in one another core . My urologist wanted to operate. I went to a radiologist he suggested AS- I sent the biopsy to John Hopkins they said I was a 3. I changed Urologist I went to Nebraska Med center he did a perineal biopsy no change but they graded it as a 4 and kept me on As. I am either a 3 or 4 and I have been on A S for 3 years.

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I had Gleason 6 on both sides when one went Gleason 7 I had HIFU. I still have Gleason 6 on one side. I am 58. No erection or leaking problems

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I am currently on AS, but only after having a year's worth of ADT with Lupron D, the last injection being May 13. My PSA is 0.1 with a testosterone level of 10, And yes, have Gleason of 4+3.
Good thoughts!

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Thank you all for your thoughtful comments and support. I am currently being evaluated for possible treatment at the Kettering Cancer Center, and, have sent in my pertinent medical & imagery records for review at the Scionti Prostate Center in Florida to determine if I am a viable candidate for focal therapy.
If Scionti believes my localized tumors’ grades (one has Cribriform cells), location and size make me a viable candidate, then I will go with them; if not probably Kettering.

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FWIW, 13 years ago I had a pre surgery Gleason of 3+3 and was told by Cleveland Clinic Chairman 50% of their patients with this score were on surveillance. I didn’t want to worry all the time so had the surgery and the final biopsy showed I was actually 4+3 or very much more advanced than the original biopsy indicated.

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I was 4+3 and did 44 radiation and 4 mos ADT. Didn’t like it. But it was better than the pain and agony of metastasis in your bones. Started ADT in May and radiation in June. Got done in Sept. I’m almost back to normal. So the sacrifice to me was worth it. I’m considered in remission.
I could easily go 5 years or more without reoccurrence.
Catch it early and you can just keep going.
You want to catch it and treat it before it leaves the prostate.

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@chamblee54

I was 4+3 and did 44 radiation and 4 mos ADT. Didn’t like it. But it was better than the pain and agony of metastasis in your bones. Started ADT in May and radiation in June. Got done in Sept. I’m almost back to normal. So the sacrifice to me was worth it. I’m considered in remission.
I could easily go 5 years or more without reoccurrence.
Catch it early and you can just keep going.
You want to catch it and treat it before it leaves the prostate.

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How’s your quality of life as related to sex life, erectile function, and continence? Every doctor I’ve consulted with said radiation kills the entire prostate, and 50/50 chance of still being able to get an erection

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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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You are right on target with your reply. Good to see someone spoke up with the gospel. Thanks!

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@paulg24

Thank you all for your thoughtful comments and support. I am currently being evaluated for possible treatment at the Kettering Cancer Center, and, have sent in my pertinent medical & imagery records for review at the Scionti Prostate Center in Florida to determine if I am a viable candidate for focal therapy.
If Scionti believes my localized tumors’ grades (one has Cribriform cells), location and size make me a viable candidate, then I will go with them; if not probably Kettering.

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Hey Paul, Cribriform cells do kick the grade up a notch - and those cells are aggressive; also, they do not respond well to standard radiation.
However, Sloan Kettering does have a protocol where they use high dose brachytherapy (seeds) in combo with either 5 session SBRT (Cyberknife) or 25 or more sessions of IMRT.
They would insert those seeds into the areas with cribriform cells for about 45 mins under anesthesia. Also, and I KNOW you don’t want to hear this, you would probably be placed on 6 months ADT to weaken the cells even more.
It’s not guaranteed to destroy your sex life but things will become challenging…
Phil

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I chose surgery with a 4+3=7. I did not like the sound of radiation continuing to make changes to my body after treatment, so I went with the knife. Final tissue biopsy showed I had some more aggressive Gleason 5 cells, so I was glad I didn't continue the surveillance any longer. I now pray that it is all gone, but the quarterly PSA tests will be the proof of that. I would not want to be praying that my 4+3=7, with some 5 mixed in, would not be spreading throughout my body to lessen quality of life, inflict pain, and kill me.

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