The fact is prostate cancer gets worse over time. People go from 3+3 to 3+4 or 4+3 over a period of years because their cancer intensifies. My brother was on active surveillance for six years his biopsy three years ago showed he had two 4+3 and two 3+4. People on active surveillance have their cancer become more aggressive over time. I know people that have had it 4+5 after being on active surveillance for a while.

While doing the Transperineal Biopsy can get to more areas of the prostate. It is very likely that the Cancer Just spread more and got more aggressive (Cribriform), though it is possible, they missed it the first time.

There are people in this forum that have had low Gleason scores, Thought they were capable of going on active surveillance, but decided on surgery and found out they had a Gleason nine.

One question is, was it large cribriform? That’s over .25 mm. That’s the real aggressive cribriform.

After six years and a few different biopsies, my brother‘s latest one did show Cribriform. He had SBRT radiation and has been doing fine for the three years since. His was specifically listed as small cribriform.

You could have a second opinion done on your biopsy. There are a couple of doctors that will do it for you. It’s about $500.. Dr. Epstein will talk to you for quite a long time about what’s found and tell you his thoughts about what it means.

Dr. Epstein biopsy
https://advanceduropathology.com
Dr. Zhou
S
Send an email to Ming.zhou@mountsinai.org to inquire about a second opinion and ask for his specific instructions for the process.