Treatment for prostate Gleason 3+4=7 PSA 10 75 years old. treqemr?

My brother had 5 sessions of SBRT radiation at 77. They did give him a six month Lupron shot. Took him almost a year for the side effects to go away. He’s now 80 and his PSA is just fine.

He was a Geason 4+3. A 3+4 probably doesn’t need Lupron.

You might be able to get cryotherapy, TULSA Pro or some other form of focal therapy.

Were any of these things found in the biopsy intraductal, cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

Look into Tulsa Pro if they already recommend cryo. Cryo was the back up procedure if they found any calcifications while doing Tulsa for my 4+3. Click on my profile to see my Tulsa experience.

For favorable intermediate (w/no other risk factors), NCCN guidelines recommend RT w/o ADT. (See attached chart.)

At 65y, with a PSA of 7.976 and Gleason 3+4=7, I chose 28 sessions of proton radiation + SpaceOAR Vue. When a 2nd opinion upgraded the 3+4 to a 4+3, we simply added 6 months of ADT to the treatments.

My oldest brother (79y) was recently treated for a PSA 5.7 with Gleason 4+3=7. (There was some suspicion of lymph node involvement.). He had 28 sessions of IMRT + 2 years of ADT.

In making your decision, also consider your other numbers and test results:
> % Free PSA
> PSA Doubling Time
> PSA Density

> with your 3+4, what is the % of “3” and what is the % of “4”

> Some of these terms (from MRIs and biopsies) if mentioned are helpful indicators: cribriform pattern, extracapsular extension, seminal vesicle invasion, perineural invasion and intraductal carcinoma.
> Biomarker (genomic) test
> Genetic (germline) test
> Results from PSMA PET scan.

With that information, you’ll have much more insight into what treatment to have.

Wishing you the best.

I had 10.2 PSA and 3+4. I was contained to the prostate and no ADT used. I had 5 treatments in 2023 on the Mridian radiation machine that has a built in MRI. I chose the machine as it exposed less healthy tissue and minimized side effects vs other radiation machines. What the doctors could see because of the MRI, they could treat. I was 69 at the time.

@bens1 Were you favorable intermediate risk. I was unfavorable intermediate, Gleason 3+4 on three cores, and a few 0+3 on other cores, making "more than half the tissue samples positive." I always had a question at the back of my mind, if the cores with Gleason 3+3 or lower are not considered cancerous, why was I unfavorable with more than half of all cores positive? I yielded to the oncologists and the urologist's determination of unfavorable, so I had Orgovyx for six months.

(A Gleason 3+4 is favorable intermediate.)

Because - unless there are other risk factors - they go by the highest Gleason score to determine the treatment regimen. (I would’ve asked them to explain why they considered a 3+4 to be unfavorable intermediate.)

@jeffmarc Not aware of the things you mentioned in the biopsy. Yes looking at cryotherapy. Do you know anyone that has had that and successful? I am told less side effects than radiation. Comment if you can. Thanks.

@dpo6508
I’ve heard of people that have had cryotherapy. It seemed to work for them, but long-term results of focal treatments like cryotherapy are still unproven.

You need to speak to a doctor that does this technique to see if you are a good subject for it.

You do have a low Gleason score which helps when requesting types of focal treatments.

@vircet
I was favorable intermediate risk

My doctor has recommended cryotherapy or radiation. I had sample around the lesion and all were negative. Has any one had cryotherapy?