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.

@jeffmarc

I've had a cardiologist for 40 years since men in my family tend to have heart attacks and die in their 40's-50's. Neurologist for about 8 years following a TIA when I had my first brain MRI. successive MRI's continue to show lacunar stroke. I'm thinking that these issues don't make me a good surgery candidate. My surgeon recommended that I read "Dr. Patrick Walsh's Guide to Surviving Prostate Cancer" which I have been reading today. I'm thinking that based on some of the content that AS may be the way to go. Something else is likely to take me out before the cancer and I won't have to worry about risks or side effects.

If AS is your decision, then you do want to aggressively monitor your AS. I would not accept the adage something else is going to get me before the prostate cancer so I will do the AS and no need to worry about risks and side effects. The general public and myself included before my diagnosis had always heard that prostate cancer is so slow growing you will die of something else. If they did a biopsy on all deceased men they would find prostate cancer in all of them. That was before my education of Gleason scores. PSA numbers, Decipher scores, Perinueral invasion, positive and negative margins, cribriform pattern, intraductal, positive lymph node , metastasis, on and on. Most people I encounter believe that prostate cancer is all one size. Yes, you can live a long time with prostate cancer, and if properly treated it can be more of a chronic disease, but you need to stay on top of it. If treated Prostate cancer can be kept in check to allow you to die from something else, but if just to throw in the towel and say I will let it run it’s course then you could more likely die of prostate cancer not with it.

I was diagnosed at 59 and Gleason 4+3/7 intermediate. Surgery was ruled out and was going to have brachytherapy but that didn’t pan out. So I went with high dose Proton radiation with ADT. I tolerated it well except for the ADT, I got 3 shots total and still battling the side effects after 3 yrs. My recent test results are PSA .11 and holding steady my testosterone is finally coming back up after 3 yrs to 271, still low but the highest since treatment. It’s been a battle and I’ve a host of other ills. I think some are from the adt but saying and proving are two different animals. Look at all your options and decide.
All the best Brother.

I had a negative MRI but decided to do a biopsy anyway. It came back with 2 cancerous cores, one at 3+4. I chose to have it removed. My post pathology report determined the core was actually 4+5. Both my MRI and biopsy were inaccurate. My point to you is make sure you are completely confident in your results before you make a decision. I feel like my experience was actually “backwards”. Still hope and pray everyday. Best wishes as you move ahead with your decision.🤞🙏

My surgeon at Johns Hopkins recommended a book to me, "Dr. Patrick Walsh's Guide to Surviving Prostate Cancer". He is very very anti ADT. He thinks that the negatives far outweigh any benefit from hormone therapy. Interesting read. He said just "say no"!

Hello!
I had the same score as you on the Gleason, PSA 6.4, and fusion biopsy results of 3 of 15 core samples positive, 3 more questionable, PET scan showing the lesion was contained to the gland. I opted for surgery vs. radiation and am doing well, PSA at 8 weeks is 0.02, urinary function, bowel function both coming on line as the nerve heals from its surgical trauma, nerve sparing approach. Erectile function is lagging, but it takes some time to recover.