Newly diagnosed T1c Gleason 3+4 awaiting Decipher results.

What percentage of the 3+4 Was a four? What percentage of it was a tumor. Were you a T1 or T2b?

Were any of these things found in the biopsy intraductal, ductal, large cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

I have an afib problem also, On Pradaxa. If they prescribe a second drug for you, do not take Zytiga, It is really hard on the heart caused me 4 afib events.

You are not far from New York City and it might make sense to go there to get treatment. There are even groups that give free lodging for cancer patients. Find out what your decipher score is that can help make a decision.

My brother had a couple of 4+3’s And at 77 had five sessions of SBRT radiation. He’s now 80 and doing fine. With a mild case you have that can be a good solution.

There are a few people in this form that have had TulsaPro And are very satisfied with it. You can go to the top level of the prostate cancer forum and search for Tulsa pro and you can find out a lot of information.

Not sure ADT will do much without radiation unless you use it long term (rest of life w/ some vacations). For focal therapy how many separate 3+4 lesions (did 3 of the 4 cores come out of the PIRADS 4 lesion?). If 4 all over the prostate may not be a good candidate for focal. See the Tulsa Pro & Tulsa Pro Insurance discussions. Higher recurrence rates but may be as good as short-term ADT alone with less side effects.

@pshea1
I had 3+4 Gleason and a psa of 10.2 plus a low Decipher risk. If I was 75, instead of 69 when I was treated in 2023, I would make the same choice; No Active surveillance, no ADT and I was treated with a SBRT MRI guided radiation machine, 5 sessions, in my case the Mridian, but the Elekta Unity is another machine. My prostate was under 60 ml. I did not want to wait to be treated as no doctor will be able to predict how your body will react in terms of growth of a tumor. They are educated guesses and are important but for me, anything can happen in a 3 month period of PSA testing. I was aware of the active surveillance discussions and predictions. Doctors are dedicated but they make mistakes and I felt treatment was less of a risk as once you wait anything can happen.

In New York City, Cornell Weill uses the Mridian and Memorial Sloan Kettering uses the Elekta Unity. Second opinions via telehealth can be very helpful for comparison purposes.

@jeffmarc thx for your thoughts and afib advice. In answer to your questions I was T1c. From biopsy report everything contained in prostate.

Right anterior medial, Gleason 3+3=6 grade group 1, 1 of 1 core involved. Tumor measures .97cm in length, 60% tissue area involved by tumor.

Right mid peripheral zone anterior, Gleason 3+4=7 grade group 2, 10% Gleason pattern 4, 4 of 4 cores involved, tumor measures 2.37cm in length, 35% tissue area involved by tumor.

@jim18 thx for your thoughts. Here is biopsy report on Pirads 4 lesion. Right mid peripheral zone anterior. Gleason 3+4=7 (grade group 2); 10% Gleason pattern 4; 4 of 4. Cores involved, tumor measures 2.37cm in length, 35% tissue area involved by tumor.

Hope this answers your question.

@pshea1
Four of four cores with 3+4 is enough to mean you need treatment not active surveillance.

Make sure that is actually what they meant to say. Were all four of those cores taken from the PIRADS 4 lesion Or were they from different spots? If from different spots that really does mean active surveillance is less attractive an option.

It might make sense to get a second opinion on your biopsy. There are a couple of places you can send it, which will review it, The doctors there are experts. It will cost you around $500 but Dr. Epstein will talk to you on the phone with the detailed analysis and cover any questions you have.

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.

With the 3+4 lesion that large can have Tulsa Pro or cyro ablation as focal treatments to minimize side effects. Like your doctor said these have lower success rates but should be better than AS or bare short-term ADT and do not preclude radiation later. Could also have radiation (SBRT, hypofractioned, classic fractions) with the higher side effects. Your choice. I would get a second opinion on the treatment plan.

I have a question about seeking a 2nd opinion. While I still have not received my decipher score yet (due within a week or two) and therefore no final recommendation from my urologist as to treatment recommendations I wanted to get a 2nd opinion appt "on the books" so I could get in sooner rather than later. What I have found is that the process of getting into Abramson Cancer Center at UPENN is to schedule seeing a particular doctor in a particular discipline and asked me who I wanted to see, which of course I didn't know the answer. Their protocol was to steer someone my age to Radiation Oncology rather than Surgery. They said they could get all my testing data online and said they didn't need my actual biopsy slides for the appt, the written report would suffice. I was assuming they would want all the primary testing materials so they could make their decision based on their analysis of my test materials. Does this sound right or do I need to be more specific about what I want out of second opinion. I'm hoping to learn whether I am a candidate for focal therapies or not and if not what specific type of radiation protocol is recommended. Or is their recommendation Active Surveillance. Does this process sound correct? Are there any other things I should be doing to make sure the 2nd opinion is with the right person? As always thank for this groups thoughts.

@pshea1 It is typical for 75+ to be steered to radiation since the stats say a recurrence is not likely before death from another cause so UPenn is not unusual. As far as the biopsy report they are not doing another pathology. Jeff mentioned several experts that will examine the biopsy slides and provide a report. This may be the same or different from the original report. I am sure they will take both biopsy reports into account with a second opinion on treatment if you have 2 reports available.

@pshea1 Unless I am mistaken, most focal therapies are done by RO’s - not surgeons. So the radiation department is the one you should ask for the consult. Best,
Phil