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

Posted by htc929 @htc929, Dec 10, 2025

 60 year old male gleason 3+4 in one location. psa went from 3.2 to 8.0 in 6 months. been on active surveillance for 2 years for gleason 6 but just turned into 7. any advice?

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harryo54 | @harryo54 | Feb 10 9:12pm
In reply to @jcf58 "As @jc76 mentions, you are going to get lots of advice (and encouragement) on this forum...." + (show)
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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.

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@jcf58 What was the procedure for the Tulsa Pro and immediate impacts or side effects. Glad your disease clear...

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jcf58 | @jcf58 | Feb 10 10:03pm

I was shocked at how easy it was. Procedure was in the morning and a little after noon I was on my way back to my home in Minneapolis. Had zero pain did not even take a Tylenol. I took my normal 2 mile walk the next morning while carrying my catheter bag😉. I only had a catheter for two days. Mayo is pretty aggressive in getting the catheter out quickly. I had no incontinence and started having sex again one week after the procedure. Click on my profile and you’ll see my full description of the procedure.

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TommyG | @tdgillett | Mar 7 6:43am
In reply to @jcf58 "@htc929 I originally thought HIFU is what I wanted, but I was not a candidate as..." + (show)
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@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.

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@jcf58 I'm looking hard at TULSA-PRO based on my most recent numbers (see my profile). My urologist was not encouraging when I told him I was looking at this option. He said "TULSA is for men with 3+4 and you're over that." Seems like it's used on patients with large prostates (me) and some with 4+3 (also me). Have been on AS since January 2025.

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jcf58 | @jcf58 | Mar 7 9:56am

I was 4+3 and a 45 cc prostate. They treated 30% of my prostate so it is now down to 30cc. Mayo said I was an ideal candidate even with 4+3 (they are treating any 7 if all other criteria are met). I did only have one lesion. I have a friend with 3+4 in 3 spots getting Tulsa this week.

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