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

@jeffmarc I am meeting with the same doctor that did my biopsy. She also does the cryotherapy. Educated at Johns Hopkins. My primary urologist said this doctor that did my biopsy sent him an email about me being a good candidate for cryotherapy.

@dpo6508 cryotherapy is another focal treatment using extreme cold, similar to TulsaPro which uses extreme heat (sonically generated).
They both work, in that they kill the PCa and avoid problems of incontinence or impotence. Did you have a Decipher Score?
Aggressiveness is a key factor in your treatment since these types of cells are very resistant - even to high dose radiation. If you have a low Decipher score - and your urologist is VERY experienced with cryotherapy - you should probably consider it.
There are no guarantees with ANY treatment for PCa, so if cryo doesn’t work you’re no worse off for trying and if it does work - you are GOLDEN!
Phil

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.

@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

Do a lot of research before choosing any treatment. Look at the Protect T trial, it is quite enlightening. At 75, I would probably do nothing except monitor.

My biopsy result was also Gleason 3+4, but my PSA was 14.5 (an adverse factor puting me in the unfavorable intermediate risk group). I learned that the intermediate risk group as a whole was extremently hetrogenous with some in the group similar in risk category to Gleason 6, while others were very high risk similar to Gleason 8 or higher. Before making any decision on what type of treatment I would seek (or even if a treatment was necessary), I had a genocmic test done: my GPS scoere was 47, showing the very aggressive and high risk biology of my cancer. If my GPS score was below 20, my risk would have been very similar to Gleason 6, and I would have definitely considred active sureveillance, intead of treatment. But given a GPS score of 47, I evaluated surgery vs radiation and settled on surgery, primarity to say "good bye and good riddance" to my very enlarged prosate which as caused me all kinds of urinary issues for many years, even after a TURP surgery. Also, both my surgeon and a radiation oncologist I consulted with told me radiation treatment will probably cause inflamation of my troubled and enlarged prostate and will likely cause urethral strictures and obstructions during and post treatment.

Bottom line: I suggest you get a genomic test before deciding a treatment is even required in your case.

@soli
I think you have written down an incomplete name for the test. A genomic test will test your genes to see if you have a genetic issue like BRCA2, ATM, PTEN and many more.

A Genomic prostate score (GPS) test is different from a standard genomic test. That’s what you are referring to.

@jeffmarc
I had the SBRT radiation, 40 sessions, in 2020 at age 77. Took lupron and ADT for one year. PSA stayed near zero until 2025. MRI and PSMA Petscan showed metastatic prostate cancer in right 2nd rib and also at spine T7. Had to go through 10 EBRT radiations. Now on ADT and Lupron, under pain management. Waiting to see what PSA does next.

@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.

Yes @jeffmarc : I am referring to the GPS genomic test conducted by MDXhealth on a tissue sample from my prostate biopsy to determine how aggressive the biology of my prostate cancer is.