Updated Biopsy Discouraging; What's Next?

The high percentage of four in your 4+3 Gleason scores is definitely saying you need to treat this.

It’s good to see that you don’t have any other negative issues like Cribriform

You might look into proton radiation. It has much less effect on other organs And might be able to resolve the bladder issues so that you could have radiation.

The pet scan will tell whether or not there has been spread outside the prostate. Nothing in the biopsy implies there is spread.

Surgery at 79 is not common. If you are in real good health it may not be an issue. There are drugs that can shrink your prostate. Getting on ADT can do that for you and might resolve the issue with the bladder. Do you have BPH? It is possible there’s an infection that made your Prostate bigger? You should ask the doctors about what you can do to shrink your prostate so that the bladder is not a problem.

First, I would consider that of all the possible Gleason scores — 6(3+3), 7(3+4), 7(4+3), 8(4+4), 8(3+5), 8(5+3), 9(4+5), 9(5+4), or 10(5+5) — your 4+3 is mid-range. Nothing to be discouraged about.

With a Gleason 7(4+3) and no other significant risk factors, your biopsy shows a run of the mill intermediate-unfavorable prostate cancer. NCCN guidelines provide recommendations to start with. (See attached.)

Based on your PSMA PET scan results, you’ll have a treatment decision to make.

During the 9 years that I was on active surveillance, I spent at least 3 years interviewing treatment specialists and evaluating treatment options so that if/when the time came to make a treatment decision (which it eventually did), I’d already have that decision (calmly) made.

(Pending your PSMA PET scan results….), during the time you were on active surveillance, what treatment decision did you make?

@brianjarvis Thanks for your response--it's helpful and encouraging. I've only been on AS for a year, so no decisions except the initial option for AS and reading, viewing videos and studying PCa. My urologist is getting me PET scanned so we'll know more after that and, yes, have some treatment decision(s) to make.

@jeffmarc Thanks for your helpful perspectives. Yes, the absence of cribriform was a plus. Prostate is 114 cc so it will take a lot of shrinking to address the size! Yes, I've had BPH for a while. When we confer after the PET scan I'll explore possibly shrinking the prostate to make radiation at least a viable option. Appreciate your frequent posts, Jeff, and your advice here.

ADT may shrink the prostate 30% In your case 34cc (3x11,4) or 78cc. The ADT duration to get there?
Prostatic Arterial Embolization (PAE) done by an interventional radiologist uses inert seed to block the arterioles in the prostate. over months the gland shrinks from lack of blood, Shrinkage permits consideration of SBRT (stereotactic beam radiotherapy) of generally 5x treatments. [The 2026 NCCN Guidelines mentions up to 7x same amount of radiation / 'isodose'], or Interstitial Radiotherapy ('Low dose radiotherapy: LDR, Permanent seeds]

@thmssllvn Yes, shrinking the gland with give RO much greater latitude.
You can also shrink it quicker by surgical remedies - TURP or various laser therapies such as GreenLight or HoLEP. These are not major surgeries, but still surgery. Best,
Phil

@tdgillett, have you and your team decided on a treatment plan? How are you doing?

@colleenyoung No decision yet. Waiting on PMSA-PET in early April. Very likely some kind of treatment is called for. I'm hoping that my tests will allow for TULSA-PRO to be one of the options. Meetings with my RO and urologist after the PET results are in. I'm doing OK, impatient for the results. I anticipate that my local team (RO and urologist) will be lukewarm about TULSA since it's not offered here. But my team manager (my wife) and I will make the ultimate decision after all the facts are known. Thanks for checking.