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← Return to Treatment for prostate Gleason 3+4=7 PSA 10 75 years old. treqemr?
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Treatment for prostate Gleason 3+4=7 PSA 10 75 years old. treqemr?
Prostate Cancer | Last Active: Dec 2, 2025 | Replies (28)Comment receiving replies
I’m 77 and been doing active surveillance for over twenty years at a center of excellence. Every one of the many biopsies until this year were 3+3. In June 2025 a biopsy came back 3+4 (5% or less 4). That institution strongly recommended radiation but I wanted to explore continuing AS because some centers of excellence are doing AS on 3+4. So I went to a second center of excellence for a second opinion. Their pathologist obtained the slides from the first institution and SURPRISE he read them as 3+3. So I’m sitting tight at present with AS even though my PSA is about 20. When I started this journey about 25 years ago conventional advice was PSA should be under 4 and 3+3 should be treated. I’ve seen enormous changes in the last two decades.
Replies to "I’m 77 and been doing active surveillance for over twenty years at a center of excellence...."
@phildphs I had a similar decision to make. After 9 years on AS (2012-2021), my Gleason 6 reached 7(3+4), PSA 4.2 reached 7.976, and a Prolaris biomarker test indicated that I had “exceeded the threshold for active surveillance.”
With the knowledge that I had gained over those 9 years of AS, I had already decided on 28 sessions of proton radiation (2.5 Grays per session) + SpaceOAR Vue.
However, in my case, a 2nd opinion UPGRADED my Gleason to 7(4+3). With no way of knowing which was right - the 3+4 or the 4+3 (since they were both educated, experienced opinions) - I chose to be treated using the higher Gleason score. So we simply added 6 months (two 3-month injections) of Eligard to the treatment regimen. (I had treatments during April-May 2021.)
That was my dilemma as well - which was right, the 3+4 or the 4+3? There was no logical way to make that decision.
@phildphs
How many biopsy’s have you had ?
I have my first one in a few weeks. Were any of yours done transrectal ?
I don’t blame you for keeping the AS. So even if the biopsy is negative for cancer will it still be a Gleason 3+3 ?
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@phildphs Imagine, all this on a matter of opinion - a coin toss determining your fate.
That’s the hardest part of this thing - knowing that nobody really knows! Congrats,
Phil