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

received my decipher result and my decipher score is .12
I have 1 location of gleason 3+4 with 10 pct of 4. There are also 4 areas of gleason 3+3. Been offered cyberknife or surgery. Am considering active surveillance and monitoring psa. Any advice?

Nice! A Decipher score of 0.12 is very good news. A case could be made to stay on AS but that 3+4 occurrence is a sign to take action. I think you could go with radiation and spare yourself the harsh side effects of an RP and still have very low odds of recurrence. See my bio for more details.

When I was diagnosed I had 2 cores of cancer, one @ 3+4. I decided on surgery as I just wanted the cancer gone, My RP went fine, including zero incontinence. However, my pathology report showed the cancer was actually 4+5. Over two years later and I’m still showing a PSA of < 0.01🤞. My advice is just make sure you are confident that 3+4 is accurate. Best wishes!

@kjacko

is it possible to get a second opinion on pathology. any advice as to where i can send them?

@kjacko It is true that a biopsy sometimes misses the worst example of cancer that one might have. So in your case if you had known before the RP that you actually had Gleason 4+5, does that reinforce your decision to have an RP? If you use the nomograms from MSK here https://www.mskcc.org/nomograms/prostate to see your odds of recurrence after having an RP, you will see that your odds of recurrence go way up if you go into an RP with a Gleason 4+5.

You will see that the odds of recurrence after an RP with 4+5 can approach 60% depending upon other factors. That is a far cry from, "I just wanted the cancer gone." If more patients understood what their real chance of recurrence was after an RP, they would realize that an RP frequently leaves cancer that had already escaped the prostate before the RP was even performed.

As such, the knowledge beforehand of high Gleason scores leads some doctors (typically not surgeons) to recommend going straight to a comprehensive radiation treatment plan rather than putting the patient through an RP first which will also likely have to be followed by a radiation treatment plan. See my bio for more details.

@htc929 Yes, you can easily get second opinions on the Gleason scores of your biopsy samples. And you will see some difference of opinions on your samples, but they will typically be small differences that can go in both directions. One doctor might score a biopsy sample at 3+4 and another will see it as just 3+3, and maybe another sees it at 4+4. But you will never see a discrepancy on the same sample range from 3+4 to a 4+5. That type of discrepancy only occurs when you compare a biopsy sample with all the tissue available from a prostatectomy. In that circumstance you might have a large score variance simply because the biopsy cannot sample all the available cancer cells.

@wwsmith

i need to be sure that my 3+4 with 10 percent 4 is correct because it was a 3+3 before. that will decide whether i get treated or not.

@wwsmith After consulting with a number of experts, I would’ve selected surgery as they all made it clear that surgery would not be possible if the radiation didn’t work.

@htc929 It’s definitely worth checking. But it’s usually a 3+4 with only 5% of 4 that has a chance of someone else downgrading the score to 3+3.

@htc929 my 3+4 got downgraded to 3+3. From what I hear, upgrading happens frequently but downgrading not as much.