Gleason 3+4, How did you treat?

@keithl56
We discussed Dr. Walsh here.

He was a surgeon who botched the surgery of a friend of mine 25 years ago and also botched the surgery for other people that are friends of people in this forum.

The guy lied to a lot of people about what he could do in surgery and then didn’t do it. Supposedly a nerve sparing specialist who didn’t know how to do it or wasn’t able to do it. The guy, I knew that went to him traveled across the country because of what he was promised. He had a very limited case of prostate cancer a Gleason, six with almost nothing found yet the doctor couldn’t spare his nerves.

I’m reluctant to believe what he tells People in his book. Maybe some of the ideas are good, but the guy has not done what he promised in the past, I don’t know if I was the rely on his information. There are a lot of other sources you can go to that disagree with that opinion about ADT.

I’ve been on for eight years, it has not been a significant problem and it kept my cancer from coming back for many years.

@keithl56

For aggressive types of cancer "no" would mean fast progression of the disease and fast decline and death !

Not all cases are the same, not even close. Many factors influence decision about any particular choice of treatment depending of that stage, gleason and aggressiveness of the cancer. Not all patients have the same bad side effects from ADT either.

Besides, biopsy is not always accurate (as we see from previous post) and was not accurate for my husband either. His biopsy showed 4+3 and in actuality he was 4+5 with VERY aggressive type of cancer.

@surftohealth88
That is hitting the nail on the head. Not all cases the same, aggressive cancers a no means fast progression, many factors influence any particular treatment ,stage, Gleason , aggressiveness, et cetera. Not all have same bad side effects from ADT. Biopsy isn’t always accurate. I do like the movement away from long term 24 month ADT in more circumstances than in the past when it might be possible.

@jeffmarc
Wow! Reading his book and other accolades you would think he was the god of prostate treatment. There are a lot of surgical technique improvements in the last 25 years. It's kind of ironic but in his book, he talks about vetting your surgeon and shopping around to find a good fit, which is what I intend to do.

@surftohealth88
You sound like my wife! Everytime I bring up AS she pushes for RARP, citing the same logic as you. She of course will be accompanying me to see the surgeon who has already indicated that RARP is likely the best route. This is a daunting journey.

@keithl56
Vetting your surgeon and shopping around to find a good fit is the one recommendation no one can disagree with.

Coming in late to this one, but I just had my 6-month follow-up, and some of this stuff we discussed, so I thought I’d share.

Disclaimer - I’m not a details guy, so I’ll do my best to be accurate, but I’m doing this from memory, mainly.

59yo (now 60), PSA at time of biopsy was 9.? A ExoDx urine test predicted 40% chance of cancer, I never had a Decipher score (that I’m aware of).

Biopsy last year showed three lesions - 3+3, 3+4, and 3+5, with 5 being 40% of that tumor, rated PIRADS-5, intermediate unfavorable. Surgeon suspected cancer had broken through the cap of the gland. Other health issues were pre-diabetes, HBP, and high cholesterol, the last two controlled with meds.

I was offered surgery or hormone shots with radiation. I looked at the side effects of each and the amount of time each treatment plan would take and immediately opted for surgery (though the surgeon made me take some time to consider both).

I came through surgery ok, after a little bump here and there, and I do have incontinence (which is steadily improving) and ED (who knows when or if that’ll get better). I’ve had two PSA follow-ups and both came back as cancer undetected.

Post-surgery pathology downgraded my most serious lesion to 3+4, with the 4 being a mere 5% (so a significant change), but did find cribiform glands present (though large or small and to what extent wasn’t specified). The report also listed focal extraprostatic extension (EPE), but pathologist in her notes said it wasn’t significant and all the extra stuff they took out, like nodes, left-side nerves, seminal vesicles, and surrounding tissue all came back negative, no positive margins, and the EPE was 0.1cm from anything else - I don’t know if that’s like a mile in cancer cell terms, or if I’d had surgery a week later, it would have gotten into something else. 🤷‍♂️ I was also reset to intermediate favorable.

Regardless of all those acronyms and numbers and strange terms, I have no misgivings or second thoughts about surgery, I’d make the exact same decision again if I had it to do over.

Incontinence and ED don’t keep me from living my life and being in generally good spirits about things, and every so often, I even forget for a while that I have cancer. Can’t do much better than that!

Good luck with your treatment!

@keithl56

Dear Keithl65 - we learned about all of this the hard way, I would not wish it to my worst enemy. 😞

I decided to be here and warn other patients of what can happen if PC is kept unchecked since I wish I found this forum much earlier and that I knew about correct PC AS protocols.

We trusted our urologist since he was recommended to us by the other extremely skilled doctor. Unfortunately that trust was placed in the wrong place, to say the least. I can not even refer to that urologist as being a person, so I purposefully used the word "place".

Also, you have many options beside RARP and consider them all. Talk to multiple doctors with different specialties and only than make your decision. We were in pure panic mode since it was discovered that my husband was 4+3 unfavorable with large cribriform and IDC after many years of AS. After RP it was discovered that in actuality he had 4+5 !!! 😢 AS can "go wrong" easily if MRI is not done every year and biopsy EVERY 1.5 to 2 years. Please be vigilant - that is all I am trying to say.

@surftohealth88

Thanks for the valuable input. If my surgeon agrees and I decide to go the AS route I plan on being very proactive in frequent testing to catch anything if my cancer progresses. I figure that if I can have a couple of years of quality of life then go through the same process as I would now, with favorable results, that may be worth it. However, the majority of the feedback that I have been getting says to get the damn thing out now. The factors that are influencing me to consider AS are:

Grade 2, favorable intermediate risk, 3+4
Low PSA - 3.9
Low PSA density <0,15
Only 10% of my 3+4 was 4 (usually under 20% is acceptable
Only 2 cores of 16 tested positive

So, I have to decide whether to throw the dice or play it safe (maybe)

@keithl56

I would add if your health is up to surgery now, that is something to consider, as health can turn on a dime and you might not be able health wise to have surgery in a year or two when you need it as I mentioned earlier most surgeons cut off at 75 and earlier for health reasons. That is if you want surgery, as very good radiation options regardless as you get older. I will say I had my surgery at your age and feel my quality of life is outstanding. I know the old bird in hand two in the bush. Your arguments support AS and AS will definitely allow your continued quality of life without much of a gamble prostate cancer wise if aggressively monitored. For me at your age it would be the dice throw for continued good health until going off AS. I might be biased regarding health issues as I have been through several always never expected. Discuss with your surgeon the pro and cons. Right now you are in the drivers seat and have time to make that decision.