Gleason 3+4, How did you treat?

Great feedback. I can relate since I also have had 2 knee surgeries, a cervical fusion, and 2 lumbar surgeries, last being a fusion. By far the most painful procedures and recoveries were the lumbar ones (although they had to intubate me while fully conscious for the cervical, which was not fun!). My Decipher score will definitely influence my decision as well.

Hello,
70 years old, with biopsy-confirmed CaP (3+4).
Some more information would be appreciated, such as:
PSA history and progression, Multi-Parametric MRI of the prostate report, prostatic volume, % cancer volume, PSAD, histology separately from both lobes, if any perineural invasion is identified, CT scan and bone scan results, if PSMA CT has been done and the outcome reported. Important: Performance status and comorbidities (ASA) with any treatment being received.
Potential options dependent on all above:
1. RP or 2. Hormones + Radiotherapy or 3. Active Surveillance.

@ioamich
PSA progressed from 1.8 to 3.9 in one year
mpMRI at JH was PiRads 4/5, prostate volume 42ccm
Pathology:
1.Prostate, Right Paramedian Apex (biopsy):
Benign prostatic tissue.

2.Prostate, Right Paramedian Base (biopsy):
Benign prostatic tissue.

3.Prostate, Rigth Posterior Apex (biopsy):
Prostatic adenocarcinoma, Gleason score 3+4=7 (Grade Group 2) involving 30% of one (1) core.
10% Gleason pattern 4
The pattern 4 in this case lacks large cribriform morphology.

4.Prostate, Right Posterior Base (biopsy):
Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group 1) involving 10% of one (1) core

5.Prostate, Right Lateral (biopsy):
High-grade prostatic intraepithelial neoplasia.

6.Prostate, Right Anterior (biopsy):
Benign prostatic tissue.

7.Prostate, Left Paramedian Apex (biopsy):
High-grade prostatic intraepithelial neoplasia.

8.Prostate, Left Paramedian Base (biopsy):
High-grade prostatic intraepithelial neoplasia.

9.Prostate, Left Posterior Apex (biopsy):
Benign prostatic tissue.

10.Prostate, Left Posterior Base (biopsy):
Benign prostatic tissue.

11.Prostate, Left Lateral (biopsy):
Benign fibroadipose tissue, smooth muscle and ganglia

12.Prostate, Left Anterior (biopsy):
Benign prostatic tissue.

13.Prostate, Target - Left Midgland PZ (biopsy):
Atypical intraductal proliferation (AIP).

no perineal invasion, no CT or bone scan performed

Comorbidities:
CAD - CAC over 1300, distal LAD FFR was last measured 2 years ago and was down to 0.76 indicating stenting should be done but cardiologist said it is unstentable. Heavy plaque burden in multivessels, particularly LAD and RM. 8 years ago was told that I have 20-25%/yr risk of a MACE but so far asymptomatic.
Chronic microvascular ischemia - same mechanism is affecting my brain with white matter disease and lacunar strokes

Rather complicated decision coming up.

The “Atypical intraductal proliferation” is a worrisome thing in your body? Do an AI search, there’s a lot of information about this. While it doesn’t specifically mean you have intraductal It is often a predictor that a more aggressive, unsampled cancer (like IDC) is present elsewhere in the prostate. That is an aggressive issue that is hard to treat.

I would want this comment clarified. “ The pattern 4 in this case lacks large cribriform morphology.”. Do they mean that they found Small cribriform?

The coronary issues are hard to treat. They can do a rotor router type treatment to remove some plaque so they can put a stent in. Looks like heart function is reduced.

Chronic microvascular ischemia (or microvascular ischemic disease) is a progressive condition where the brain's tiny blood vessels narrow or stiffen, restricting blood and oxygen flow. It is a major cause of white matter lesions and cognitive decline. Primary management focuses on strict blood pressure and diabetes control to prevent further brain tissue damage or stroke.

Definitely need to see a cardiologist and for brain issues, a neurologist.