Gleason 3+4, How did you treat?

My PSA was 7.8 at 66 y/o and a mpMRI found 3, 4 & 5 PIRADS lesions. Had a TRUS biopsy in Oct '23 which found 7/15 cores positive…five 3+3 (5-10%) & two 3+4 (10-20%). My Decipher GRID indicated “Low Risk" @ 0.22. I began AS immediately and just turned 70 y/o in June.

My 12 mth mpMRI indicated that the two smaller lesions were no longer visible and my 28 mth mpMRI indicated all three original lesions were no longer visible. One small PIRADS 4 lesion (92% smaller than the original PIRADS 5 lesion) was found in the most recent mpMRI, but my urologist indicates there's a low risk (< 5%) of clinical significance, due to its central anterior gland location. My current urologist now believes the original mpMRI lesions were inflammation...

My most recent PSA was 6.5 and it has never increased over my prebiopsy level, which I have checked every three months.

As you have CAD, my AS protocol may not be suitable in your case, you certainly would want to check with your cardiologist before attempting any such activity. I crafted an AS program around the protocol defined in the the ERASE RCT. Just today I ran my normal Zone 2 5K followed by two quarter mile HIIT runs....I do this 3 times a week.
https://jamanetwork.com/journals/jamaoncology/fullarticle/2783273
All that said, I would definitely get a Decipher score. In my case, it was the key piece of confirmatory information regarding my AS decision, which is especially important when trying to decide what to do after a 3+4 diagnosis.

In any case, you have time to do extensive research (if that's your inclination) before making any treatment decision.

Thanks - good input. I would love to run but after my last spinal fusion my neurosurgeon said no more impact sports (or torquing). It drives me crazy because I live on a golf course and there is an active tennis/pickleball community and I can't partake in any of it. I can't believe that I hit the health trifecta - coronary, neuro, and now cancer!

The Decipher score is definitely a good idea, and others have suggested PET as well. I don't want to rush into anything because my schedule is pretty full (birthday this month, 50th anniversary next month, trying to get my northern house on the market, officiating my grandsons wedding in November, and of course the holidays). No good window for extended downtime, but I have to be realistic.

@keithl56
Don’t worry nothing really you need to do regarding the Decipher but a phone call to your Urologist or whoever performed your biopsy and request they do it.

@keithl56
I think that RT is much easier on body than surgery in cases when other serious health issues already exist, especially heart issues.

General anesthesia is hard on body and effects both heart and the brain. I suppose you must be on blood thinners now and you will have to stop them to have surgery and that would put you at risk of developing blood-clot : ((.

My husband had surgery and he recovered in record time but he does not have any health issues and is in great physical shape in general.

Many had much longer recovery than him. It is very individual indeed and depends on so many factors. I am not a doctor, I can only tell you my opinion and what I would have chosen for my husband if he had serious heart problems or previously had a stroke. It would most definitely be RT.