Was on active surveillance, now gleason 3+4: Any advice?

Frist, you are going to get a lot of advice. Please remember do what is best for you with consultations with your doctors. If you don't have experienced doctors consider second opinion.

Are you seeing an experienced urologist. What has he/she recommended? The Gleason 6 recommendation you got seems to mirror what most urologist recommend but have seen some post where this is not all. I assume you had another biopsy and it turned into 7. What was the score 3+4=7 or 4+3+7. Asked your urologist why that score is listed that way (or you can research on line) and what is means. It does make a difference how it is listed and passing this to you not as medical expert but from my experience with my Mayo urologist, UFHPTI R/O, Mayo R/O, and Mayo PCP).

Talk to your doctors about treatment plans and you decide what is best for you. How old you are is a big determinant. The Gleason score increase of 1 over two years is significant and needs further medical attention especially further test like Decipher, PSMA, etc.

What are your medical doctors recommending. They know your medical and mental health history and are there to provide medical guidance to you. If you doubt their expertise or want more guidance I would get a second opinion once you get their treatment plan.

I had a 3+4=7 and a 4+3=7 and was diagnosed as intermediate risk. But my R/Os recommended the Decipher test. That Decipher test came back low risk. That diagnosis changed my treatment plan from radiation and hormone treatments to just radiation. I also got 2 different opinions from two very experienced medical institutions and doctors. I had 30 rounds of proton radiation as wanted the possible help of reduced secondary radiation damage and secondary cancers that proton could possibly help reduce.

Just know at this point lot of information and choices coming your way. Now for some inspirations. When PC is caught in early stages and confined to prostate the success treatment rate is very very high (almost 100%) per my Mayo urologist, UFHPTI R/O, and Mayo R/O.

That is a substantial jump. Pretty sure your doc will want MRI and then a biopsy. Your 3+4 could have grown in size or stepped up to a higher Gleason Score. Best,
Phil

3+4 was the result of the biopsy on dec 8th

As @jc76 mentions, you are going to get lots of advice (and encouragement) on this forum. You need more information but it looks like many options will be available to you. I did Tulsa Pro at Mayo in 2024 for my single spot 4+3. No evidence of disease at this point. Second opinions are always good. I actually talked to 7 doctors before making my decision. Good luck.

My mri showed a “suspicious area”. I had my biopsy done Dec 1 with 3+4=7 but most of my right side was cancer and some in my left side, which my Dr rated as “Intermediate unfavorable”. I am awaiting a call to schedule my PET scan (head to knees) to see if there is anything in the rest of me. Then a consultation with my Dr on Jan 6 to see where we go from there.

Similarly, at 56y/o with a localized, 3+3 and PSA of 4.2, I was on active surveillance for 9 years (April 2012-April 2021). Gleason eventually hit 3+4 and PSA reached 7.976.

> With your 3+4, what % was “3” and what % was “4”?
> Was there any mention of cribriform pattern, perineural invasion, Intraductal carcinoma, extracapsular extension, or seminal vesicle invasion in the MRI of biopsy reports?
> Have they done a biomarker (genomic) test, genetic (germline) test, and PSMA PET scan? Those will provide more information you need.
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In my case, as my PSA continued to rise from the original 4.2, I knew that I’d have to eventually make a treatment decision. So, I spent the last 3 years of those 9 active surveillance years getting referrals to specialists, researching and evaluating treatment options (becoming a “student of prostate cancer”), and deciding on what treatment would be best for me when the time came that I would have to “pull the trigger.”

One of the understandings I had with my doctors was that quality-of-life and successful treatment were equal priority for me. That set the basis for us working together and agreeing on a treatment plan.

So, with success rates comparing surgery with radiation being statistically equivalent no matter what treatment chosen (https://www.nejm.org/doi/full/10.1056/NEJMoa2214122), it all came down to side-effects and quality-of-life (or as that paper concludes, “… the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer.”).

Ultimately, at 65y/o I decided on 28 sessions of proton beam radiation and SpaceOAR Vue. (The Gleason was later upgraded to a 4+3 so, we simply added 6 months of Eligard to the treatment plan.)

You’re going to have to decide which treatment is best for you given all the specific details of your diagnosis, your life priorities, as well as what side-affects you’re willing to deal with.

Prostate cancer has a very low mortality rate so, I wouldn’t even factor that into my decision. Follow the numbers, keep your emotions in check, and don’t think dark thoughts — you’ll make the right decision.

@bbqpitmaster
The PET scan is good for more clear diagnosis of whether spread outside of prostate.

Did you doctor mentioned the Decipher test. If not asked him/her about that test.

in the 3+4, 90 percent was 3 and 10 percent was 4. i havent talked to dr yet. the results just posted last night

I recommend Surviving Prostate Cancer by Dr Patrick Walsh. Also, you have already gotten some GREAT advice here, lots of knowledgeable people on this forum have responded to you

We are in a similar situation, and I chose surgery (coming up this Tuesday). I talked to many doctors and almost all said the same thing - continue active surveillance or treat with radiation or surgery. One said radiation and not surgery.

There's not just one answer, it's complex. My advice (and trust me, I am NOT one of the knowledgeable people on this forum) is once you have made a decision then next make peace with it. For me, I had other options, but I chose surgery at Mayo Jax and I will never look back.

I wish you good luck.

thank you all. i am still waiting for doctor to call. anyone know anything about hifu. thats what he specializes in and thats what im sure hes going to recommend.