Sometimes the worrying is worse than the prostate cancer itself. Sit back, take a breath, and review the areas in your test reports that matter.

Try to avoid making assumptions if you’re not sure what the results mean. Otherwise, your mind will take you to dark places…..

During a biopsy, they always do random samples around the lesions identified in the MRI, because there is a chance of unseen lesions being within a certain distance away.

With your 15 samples:
> Gleason 7(3+4): [Cores A, C, E, F, M]
> Gleason 7(4+3): [Cores B, D, H, J, L]
—> With Cribriform pattern
> Benign: [Cores G, I, K]

They’ll treat you per the highest Gleason score.

What that Cribriform pattern means is that it’s a little more advanced than your run-of-the-mill 7(4+3), and that they’ll treat it one step higher (like a Gleason 8). That happened with my brother and me - I had a run-of-the-mill 7(4+3) so, I had 28 sessions of radiation + 6 months of ADT. He also had a 7(4+3), but like you he had additional risk factors so, he had 28 sessions of radiation + 2 years of ADT.

Again, don’t let there numbers take you to dark places. With today’s medicine, there are solutions to each of them.

A Gleason score is a number assigned to a lesion based on the appearance of the cells under a microscope. In your case you have a Grade Group 3 (Gleason 7(4+3); see attached graphic), but with Cribriform pattern - holes that look like Swiss cheese, which is a higher risk factor warranting slightly more aggressive treatment.

For me, getting my results prior to talking with them was great because that gave me time to investigate, become knowledgeable, and come up with questions so that I wouldn’t go to the next appointment cold and be blindsided. You should use this delay as an opportunity to get more informed.

Statistically, just getting it “cut out” provides no advantage over radiation. For localized prostate cancer, success rates are statistically equivalent; you just have a different set of quality-of-life side-effects to deal with.

Yes, a prostatectomy does take 100% of the prostate out. (When I had these basic questions, my urologist brought out an anatomically-correct plastic model of a male pelvis, and showed me what goes on during a prostatectomy. You should ask your urologist to do this; or search YouTube videos for prostatectomies.)

Most of your questions are very basic questions. You need to take the time to research all the questions you asked about surgery (all the different types), radiation (all the different types), and hormone therapy (all the different types you didn’t ask about), and all the plusses and minuses of each, because eventually it will be up to you to make the decision of how to proceed with which treatment (not the doctors).

Your age matters, too. At 78y your priorities are probably different than someone at 48y.

At 65y, I had 28 sessions of proton radiation + 6 months of hormone therapy + SpaceOAR Vue. At 79y, my brother had 28 sessions of IMRT + 2 years of hormone therapy + fiducial markers. We’re both doing fine with little quality-of-life impact. For me, the decision-making and choice wasn’t difficult; it just took time. And I helped guide my brother; his decision came more quickly with my assistance.

As for any type of treatment, they always have to do it right. With today’s modern radiation, they simply have to avoid over-shooting the prostate; that’s it. If they overshoot the prostate, there will be side-effects; that’s why I chose proton.

Again, learn all that you can; don’t let your emotions guide your decision-making. Choose well.
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