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

@htc929 I originally thought HIFU is what I wanted, but I was not a candidate as my lesion was anterior and too far from the rectum. My Doctor mentioned Mayo was doing some advanced ablation options and I found out about Tulsa Pro. Tulsa seemed to be HIFU on steroids. Uses the same Ultrasound waves to ablate but it is done in an MRI machine (the ultrasound is thru a probe in your urethra) to ensure precision in targeting and achieving the required temp to kill the cancer cells. Sounds invasive but I literally had zero pain afterward. Click on my profile to read my story.

@jcf58 mine is left anterior lateral is that not an option for hifu. who can i contact about tulsa pro. which mayo location is it done in. thank you

@htc929 Note that a genomic test is different from a genetic test.
> Biomarker (genomic) test: Looks for genes, proteins, and tumor markers that tell more about the prostate cancer. (There are many genomic tests - like the GPS test mentioned.)

> Genetic (germline) test: Tells you which genes you inherited from your parents. (like BRCA1/2, ATM, CHEK2, HOXB13, MSH2, etc).

You should get both types of tests.

I took was diagnosed with a 3+4 lesion in May this year. On the surface 3+4 (w/high percentage 3) looks like "favorable intermediate risk cacer", but your PSA velocity from 3.2 to 8 in 6 months is concerning if it was not caused by other factors like inflammation or infection. It turns out the 3+4 group is an extremely hetrogenous categroy with some in this group behaving biologically like 3+3 while others behave aggressively like Gleason 9 or 10. So, how do you know which subgroup you belong to? Fortunately, there are simple tests to do just that,

Given your high PSA velocity, you should ask your urologist to send a sample of the biopsy for a GPS (Genomic Prostate Score) test which will detemine the aggressiveness of the biology of your cancer. That is exactly what I did and my GPS score came out as 47 on a 0 to 100 scale: less than 20 being low risk, 20 to 40 being intermediate risk, and 40 to 100 being high risk. If my GPS score was less than 20, I was going to consider going on active surveillance, but given a score of 47, I agreed on a definitive treatment of prostatectomy which resulted in a final pathology of 3+4 but with several riks factors like seminal vesicle and extra capsular invasions.

So, in your case, I suggest you get a GPS test before deciding to remain or active surveillance or seek definitive treatment. I also concur with a suggestion earlier of geting Dr Patrick Walsh's book "Guide to Surviving Prostate Cancer" which is very comprehensive, readable, and understandable, with a summary at the beginning of each chapter to get a quick overview.

@htc929 I originally thought HIFU is what I wanted, but I was not a candidate as my lesion was anterior and too far from the rectum. My Doctor mentioned Mayo was doing some advanced ablation options and I found out about Tulsa Pro. Tulsa seemed to be HIFU on steroids. Uses the same Ultrasound waves to ablate but it is done in an MRI machine (the ultrasound is thru a probe in your urethra) to ensure precision in targeting and achieving the required temp to kill the cancer cells. Sounds invasive but I literally had zero pain afterward. Click on my profile to read my story.

@jcf58

i reached out today to yale medical center today for an appointment for the urology doctor there in charge of the tulsa. I will send them my records tomorow

@soli The first RO that I ever talked to was a doctor from India that worked for Baylor Scott and White in Temple, TX. I too had a 3+4 case and just like you mentioned in your post this doctor said that 3+4 cancer is highly variable. Rather than say 3+4 is an extremely hetrogenous category, he used the more colorful expression that 3+4 cancer can be a pussy cat or a tiger or anything in between. He said that what we really need to do is perform a genomic test (Decipher) on the cancer cells from the biopsy to really see what we are dealing with.

@htc929 Good luck. Don’t hesitate to ask more questions 😉

@htc929

Tulsa
https://tulsaprocedure.com/find-a-tulsa-pro-center/
https://tulsaprocedure.com/
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Here is my post on Tulsa Pro from more than a few years ago
https://connect.mayoclinic.org/discussion/tulsa-pro-initial-experience/

@htc929 mine was at Mayo Jax