Received the news on Halloween. I have prostate cancer. Need advice.

3+4 is not life threatening. Basically, just keep an eye on your PSA. Any significant increase in that number beyond 6 and you will initially be put on hormone treatment to stop your testicles producing testosterone which cancer needs to feed on.

@brianjarvis
Regarding 2nd opinion of biopsies. Since UCLA facility is one of the center of excellence, I am not sure if other facilities will disagree with their findings? But I will certainly ask the doctor who did the biopsy on me, next week.

As to the words cribriform pattern, extracapsular extension, seminal vesicle invasion, perineural invasion or intraductal carcinoma ---> On their pathology report, total 18 cores were extracted. There is a table for each core. There are 3 columns: Crib4, IDC, PNI. I looked it up, they refer to Cribriform, Intraductal Carcinoma, and Perineural Invasion. None are checked.

For PSA numbers. It is 5.4 and Prostate size is 59cc, so density is 0.09. No free PSA number this time. For PSA doubling time, I asked chat gpt. Since last PSA was 4.5. So, doubling time is 3.5 years?

Than you for your thoughts

Frank: Given you are a UCLA patient, I would inquire about Tulsa Pro if they suggest treatment. I know they do it there. It is minimally invasive and risk of side effects are low.

@kjacko
I now can see how biopsy can be a game of chance, instead of total accuracy. I have 2 lesions that did not grow for a year. Their sizes are 1.2cm and 1.4 cm. Last year the same UCLA doctor did the targeted biopsy, with 3 cores of each and came back all benign.

A year later, one shows a Gleason 6, and one shows Gleason 7 (3+4). The needle is small. It may only hit the area with cancer but left other areas untouched that might be worse. Only surgery removal can check the whole lesion.

@jcf58
Yes. The doctor who did my biopsy twice is part of their Tulsa Pro team. Next week, when I meet with him, I will certainly ask for the qualifications of being a candidate for that procedure. The challenge that I see is, I have 3 cores with cancer, and they are in 3 different locations. Partial ablation might not be possible. I may need total ablation if I chose Tulsa Pro.

I think you are following the standard protocol fo this type of event. Your doctor seems very thorough and conscientious so a deepening of trust might be in order. In addition, I might suggest that you stay aware of your level of fear. From my perspective it can lead to suffering. Best of all things to you on this journey…

@frank1956 A few years ago, I was in a webinar with Dr. Jonathan Epstein (Johns Hopkins) as the speaker. He made a comment regarding 2nd opinions that was something like “If two pathologists agree 2/3rds of the time, that’s considered good.”

(Prior to starting my proton radiation treatments, a 2nd opinion upgraded my Gleason from 7(3+4) to 7(4+3). Not knowing which was “right” - the 3+4 or the 4+3 (since they were both educated, experienced opinions) - I chose to be treated per the higher Gleason. So we simply added 6 months (two 3-month injections) of Eligard to my treatment regimen.)

That’s good that none of those terms are mentioned in the MRI or biopsy reports. Some of those terms are indicators of more advanced disease.

Regarding Free PSA. That’s not a standard PSA test, but they’ll do it if you ask. PSA circulates in the blood in two forms – either attached to certain blood proteins or unattached (“free”). If the PSA is between 4.0-10.0, but the % of Free PSA is low (< 25%), it may indicate a higher disease risk. (Another datapoint in the decision-making process.)

PSA Doubling Time (PSADT) –> The number of months it takes for PSA to double. If the PSADT was < 10 months, patients tend to do worse. (Again, just another datapoint in the decision-making process.)

@frank1956 I am sure that was spooky Halloween news for you. I am a UCLA patient as well (soon to be 74 yo) with similar Gleason scores (3+3 and low volume 3+4) on initial biopsy 10/2021. Low Oncotype scores and negative for BRCA mutations, I was recommended AS. After 4 years my PSA escalated and biopsy showed transition to Gleason 4+5 with unchanged MRI and PSMA PET Scan localized disease. AS allowed me 4 years without intervention, though with the changes this summer treatment clearly was necessary. I just completed high dose SBRT regiment at UCLA Radiation Oncology and started ADT (planned for 12-18 mos per RO). Good luck to you on your journey.

My results were similar and I was going to be on active surveillance until my Decipher score was high enough to cause concern. But, even with that, I had plenty of time to get my ducks in a row before doing anything and I talked to 9 different doctors (urologists, medical oncologists, radiation oncologists) to make sure everyone was on the same page, and they were, so out it came. So far, so good, no side effects and doing well.

Now that you have been given more time, make use of it and find out everything to know about PC and talk to every doctor you can - especially while in the final throws of this deductible year!

The optimal radiation dose is provided by Interstitial Radiotherapy (a/k/a permanent 'seeds', low dose brachytherapy, LDR brachytherapy. Go to PCRI.org YOU-TUBE video entitled Brachytherapy 101, listen to the Q & A afterwards for other clinicians qualified to preform it, Also see results of the 2025 of the Annual ASCO Meeting on that same website. There is a problem with recommending 'LDR' its reimbursement return is too low.