Responding to the original statement offering: I too was a Gleason 3+4 = 7 "at the time of 12-core samples biopsy." I had 3 normal/negative cores, 3 cores rated 6, and 6 cores rated 3 + 4 = 7 with only 10% being "4." I also had perineurial invasion. My physician lulled me into a confident and secure mindset. However...
The problem with "biopsy" pathology reports is the most they can offer in addition to Gleason score is whether there is that "perineurial invasion". When I wanted to discuss my options including "active surveillance", my Urologist gave me an odd facial expression and flatly said: "I'm taking your prostate...there is no benefit to actively surveilling you if you already have even 10% "4" cells. Watching you for two years will just mean that we gave the cancer more time to grow and advance in staging, perhaps even spreading to your seminal vesicles and lymph nodes." Well...
I had the single-incision, DaVinci robotic-assisted radical prostatectomy surgery April 18, 2025. The "surgical pathology" report was more ominous: I had "Extra-Prostatic-Extension (EPE)", and it had just spread into my left seminal vesicle (surgeon took both seminal vesicles and both vas deferens as well), and...I was one of the unlucky 10-20% that had "surgical margins", meaning of course, that my Urologists "didn't get all of the prostate/cancer" ...some was left behind. That makes me a p3Tb, with a less optimistic, long-term survival. NONE of that was seen or could be known from the biopsy itself. In other words, you don't really know how serious your cancer is until your prostate is removed, and a full pathology exam and report are done.
The fact that I had EPE, seminal vesicle invasion, and "surgical margins" was a huge game changer. At the time we reviewed my biopsy report, I joked with my physician: "As long as I am here for my son's 40th birthday in fourteen years." He laughed and said "of course you will be...and well beyond!" When I saw him two weeks post-surgery for catheter removal and discussion of the surgical pathology report, he was more serious saying: "We'll need to talk about radiation at your 3-month follow-up."
A lot will depend on what my PSA is a three months. Hopefully, < 0.01 ng/ml. If so, then we still may do radiation because we both know that my Urologist left cancerous prostate tissue in my body, and it will start to grow and spread. The nature of p3Tb is that despite radical prostatectomy, it just tends to come back. Survival rates are more like 5-10 years instead of 15-20.
Caveat: My father lived to 99 years 10 months old "with" prostate cancer that was never operated on with a prostatectomy. He suffered a lot with perpetual UTI's and hospitalizations, but never had the prostatectomy. My maternal grandfather lived with his prostate cancer until age 96 years. He never had the prostatectomy. My maternal uncle lived with his prostate cancer until suffering a non-associated massive stroke at age 86. You're thinking: "ahhh...familial tendencies...genetic propensity." Answer: No. I had genetic testing done. I have no cancer genes in my body of any kind. I am the perfect example of the 70 year male who falls into what is now the: "One in five men will have prostate cancer sometime in their life" category.
I agree with the original comments above: we are strangers on a public blog-like website sharing our stories and a bit of cautionary advice. We should not believe everything we read, but...perhaps my offering here will lead to more discussion with your physician about the futility of "active surveillance" if you already have even as low as 10% "4" graded cells. You don't really know how extensive your disease is until the prostate is removed. I went from confidence for a long, typical survival and life thinking I will "die of something else other than prostate cancer" as is often quoted, to now wondering if I'll live more than just five more years with or without radiation.