Gleason 3+4, How did you treat?

With your 7(3+4), what % is “4”? What is your PSA?

Are any other risk factors mentioned in either the MRI or the biopsy report: cribriform pattern, extracapsular extension, seminal vesicle invasion, perineural invasion or intraductal carcinoma?
=========

When diagnosed with a localized, 3+4, with PSA of 7.976, at 65y I chose 28 sessions of proton radiation. When a 2nd opinion of the tissues came back a 4+3, (not knowing which was right) I chose to include 6 months of ADT. That was 5 years ago.

That was my case, my lesion was also benign. The cancer was found elsewhere. Go next for the decipher test and PET scan. If decipher low and PET has it contained along if your biopsy report is otherwise favorable in other factors you could consider AS. However your age is a factor and if you are in otherwise good health depending on the severity of your CAD you might consider surgery. If you decided to go AS and your health declined you might not be eligible for surgery later as after it is 75 that is generally considered cut off by most surgeons for surgery, but you will exception’s on this board who were older and did get surgery. Now speaking of surgery only as that was my experience at your age, it is important to learn about really the two techniques to performing the RALP. One is newer and seems to provide quicker healing, quicker continence and lesser ED if nerve sparing is also performed. It is called a Retzius sparing technique. Please research so you are aware of your options when you make an informed decision.

With 3+4 I choose RARP because I had the "get it out of me before it spreads" mindset, since my brother passed away with metastatic PCa. I also wanted to keep all options open in the future and it's a much easier route to have radiation after RARP than in reverse. I had a closed mind about radiation (my brother had awful side effects), but would suggest you understand all types of radiation options and keep it in consideration. From what I understand, proton radiation is a great option.

Getting a second opinion on your biopsy pathology report is a good idea. I had different COEs give different Gleason scores. Hope this helps some.

The 4 is only 10%, and another sample came back 3+3. No Cribriform. PSA is only 3.9, up from 1.8 1 year ago. My CAD is relatively severe (CAC of 1300) and my cardiologist told me 8 years ago that a would have a major adverse cardio event within 5 years, but here I am! I also have white matter disease and lacunar strokes from the same artery clogging mechanism but so far have no major effects other than balance/gait issues.

My surgeon at Johns Hopkins is up to date on latest techniques and Davinci (and I believe Retzius), is actually doing a clinical trial now on aquablation. I feel relatively confident in him. It will be interesting to see what options/recommendations he has during my f/u visit.

Thanks for the input.

I am 61 with no health issues, other than PC. I am scheduled to
have RP surgery in September. Larger lesion, 3+4, with lesion along prostate capsule.

In your case, I would not consider surgery, from all my research.

In your case, I would not do any treatment, unless information indicated cancer was progressing/changing.

Others have more experience than myself, but I would be looking at:

1. Check PSA every 6 months for the next few years. PSA will vary over time. Long-term trends mean more than single tests.

2. Two cores indicates you are likely in the earlier stages of PC.

3. As long as MRI and biopsy testing does not indicate possible extracapsular extension or possible PC outside of the prostate, delaying treatment likely makes sense.

4. I would not treat until information from tests indicates treatment is definitely best. At this time, some form of radiation would likely be best choice.

Best Wishes.

Mine was 3+4 after biopsy 16 years ago. I decided to have Surgery because my father had radiation and died from prostate cancer. After surgery, it was a 4+3. Somebody just mentioned a couple of days ago in this forum that before surgery they were a 3+4 and after they were a 4+5. This is not all that uncommon, Quite frequently the biopsy, Which only gets 1% of the prostate, Doesn’t include some of the more aggressive parts of the prostate.

We need to take a look at what percentage of the cores that had a 3+4 was cancerous and what percentage was a four. Also, how many cores were a 3+4 and how many were a 3+3. If there are more than six cores Involved then it might be important to get Treatment right away. If there were very few problem cores found than you could possibly go on active surveillance.

Thanks. The number of cores and the percentages aren't that bad, but I have seen many men refer to having a significant findings post surgery. Definitely something to seriously consider.

@charlesprestridge

Appreciate the input. I would definitely prefer AS at this point. I'll see what they say at JH.

I am so sorry to hear that and my heart goes to you : (( .

I think that for that reason and because you are 70 , and because you have 3+4 gleason that radiation would give you the least problems.

Since you have low gleason score, according to new guidelines, you will not need ADT which can effect heart issues. You are getting care at great hospital and if I were you, I would go with what they suggest for you.

SA is very plausible approach also depending of life expectancy but if gleason moves upward you will than possibly need to be on ADT to get full benefit of RT. It is very tough choice indeed, but I am sure that you will get good advice from John Hopkins doctors. 👍

thanks for the comments. Why do you think radiation would be preferable?