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

@heavyphil When we got a 2nd opinion on my 3+4, (instead of a coin toss & with no way of knowing which was right) I made the decision (even before the results came back) to get treated to whichever was the highest Gleason:
> should the 2nd opinion come back a 3+3, I would still get treated to the 3+4;
> should the 2nd opinion come back a 3+4, I would (of course) get treated to the 3+4;
> should the 2nd opinion come back a 4+3, I would get treated to the 4+3.

As it turned out the 2nd opinion came back a 4+3, so we simply added 6 months of ADT to the 28 proton radiation treatments.

@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 ?

@brianjarvis Well, Brian, maybe in your case the coin toss wasn’t necessary - you WERE getting treated, no matter what.
In the other case, one man thinks he sees one thing on a slide- another sees something else. That difference of opinion ONLY - a visual impression in fact - is the arbiter of continued AS or the plunge down the rabbit hole of treatment, with all its SE’s, warts and all. When you think of the difference physically between ‘we’ll see’ or ‘you need surgery’ it really IS a big deal. Kind of like guilty or innocent based on nothing more than your looks…Best,
Phil

@indyguy I’ve had about 15 biopsies over the last 25 years. Two or three of them were completely negative, the remainder were all 3+3 except the one most recently in 2025 was 3+4 according to one institution and 3+3 according to the second opinion. Until recently all the biopsies were transrectal until transperineal came into vogue. I was lucky in that I never had significant trouble with any biopsy but my preference would be transperineal due to suspected less risk of infection. At age 77 I am willing to continue with active surveillance and take the risk of metastasis in the next 10 to 15 years if I live that long. It’s just educated guesswork about the risks of treatment versus the risk of metastasis and the inevitable fact of death from some cause at my age. Finally since you are facing a first biopsy I would say the first few can be nerve racking but after that they just become routine and no big deal. There is a lot of great information on YouTube videos about all kinds of prostate cancer issues but it takes a lot of time and research to delve into the numerous issues involved.

@heavyphil That’s what’s interesting about prostate cancer diagnosis and treatments - It allows for approaching similar problems from different directions (sometimes leading to different treatment decisions) - and then having to live with that decision.

For my prostate cancer related decisions, I let the numbers guide me - for better or for worse - to a conclusion. I wouldn’t look at staying on any particular treatment - unless the numbers and test results clearly indicated so. (I think this defines my philosophy on decision-making in general, because I eat, live, and breathe numbers.)

Especially given the inherent uncertainty of different pathologists’ experienced and educated opinions of interpreting biopsy slides - “one man thinks he sees one thing on a slide; another sees something else” - my nature is to take the more cautious approach (i.e., treat to the higher number).

Similarly, taking the more cautious approach and taking known precautions significantly minimizes the risks of “plunging down the rabbit hole of treatment, with all its SE’s, warts and all” (of which as a result, I experienced few).

I knew that at some point my “we’ll see” must become actionable. After 9 years on active surveillance (of which the last 3 years were spent taking a deep dive investigating and evaluating treatment options), I knew that I had to have an actionable plan in place for if/when a treatment decision had to be made.

It was that same numbers-guided decision-making process that for me, has made this just another medical decision to be made - no differently than I would do any other.

I have attached a link to an article about the GPS genomic test on a biopsy sample of 3+4 intermediate risk patients, and how its risk stratifications can assist one in making decisions about whether a definitive treatment is required, or active surveillance is an option: https://www.pcmarkers.com/gps-results

@phildphs
Thanks for your reply. Wow 15 biopsy’s😳
I am definitely not looking forward to my first one. Did you just have a few days of passing blood in your urine ?

I really dread the phone call with the results even more..that is very nerve racking to me. How many lesions do you have ? From everything that I have read once you start with a biopsy it seems that it is a never ending thing. Seems like they should just remove the prostate at birth so we don’t have to go through this lol.
Wonder how many biopsys come back completely negative instead of Gleason 3+3 ?

I know a lot of men just jump to having their prostate removed instead of worrying about AS. I would definitely wait and put it off as long as I could like you.

@indyguy in my view if a biopsy comes back 3+3 you have the luxury of plenty of time to figure out what, if anything, you want to do. Now days the standard of care for 3+3 seems to be active surveillance whereas 20 years ago men were very frequently being treated for 3+3. It was almost heresy to do active surveillance 20 years ago. Today things get murkier if the biopsy comes back 3+4. It took me a lot of research to understand the risks and benefits of whether or not to treat a 3+4. The facts are different in each case so comprehensive testing and research is necessary. There are many excellent videos on YouTube. For a start try Dr. Mark Scholz, Dr. Laurence Klotz and Dr. Cooperman. It is a lot of work to figure out all of this. Finally as to your question about passing blood in the urine for a few days, that did sometimes happen to me but was never a problem. There can also blood in the semen for a month or two but that was not a problem. I never had an infection after a biopsy, possibly just by luck.