Possible treatment options for 2 positive core samples

While you do have 2 3+4 lesions Overall, you are not really in a bad place. This is a pretty mild case. You can get this treated and it may never come back.

Yes, The test you got shows high reoccurrence, but your biopsy doesn’t really show that much.

Were any of these other things found in the biopsy intraductal, ductal, large, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

You could have surgery or radiation and it might leave you with many years without having to worry about anything.

You can even have focal therapy and come back later for radiation or surgery.

Are the 2v3+4 lesions located near the same spot in your prostate? If so, you can have multiple different types of focal therapy to take care of that area and leave the rest of the prostate untouched.

You may want to get a second opinion about this. See what your doctor has to say and come back and let people mull it over.

On my mri one .8cm lesion found biopsy showed right base lateral 3+4 20% involvement, right base medial 3+4 30% involvement that's it how does that equate to high chance of reoccurance.

No perineural invasion no cabriform, carcinoma conventional acinar type.

@ginger38314, how did your follow up appointment go? What treatment options were discussed?

My appointment is today and will keep members posted when I find out.

Had my follow-up appointment for my 2 of 12 core biopsy 3+4 Gleason score and a 20% and 30% involvement on each, doctor offered active survalance but I declined if it was 3+3 in the same senerio I would have done it, he was leaning towards prostate removal versus radiation because of options after reoccurance but referred me to an oncologist and a surgical urologist so I will make an appointment and schedule removal surgery but will talk to oncologist and see what they say and that's 2 to 3 weeks off so will see what happens.

Sounds like a good plan.

What they look at with the 3+4 when they consider active surveillance is how much “4” there is. If it’s only 5% “4”, that’s different than if it were 45% “4”.

You might also consider getting a 2nd opinion on that biopsied tissue — not necessarily because you don’t trust the 1st one or don’t like that opinion. But, because much of the interpretation of images and scans is often as much an art as it is a science, and is dependent on the skill and experience of the pathologist reading the slides. It’s good to have an independent set of eyes reviewing the biopsy. (What one pathologist might see as a 7(3+4), another might see as a 6(3+3), while another might see as a 7(4+3).

As for options if there is local recurrence, with modern primary radiation you have many options - focal therapy (e.g., cryo), brachytherapy, SBRT (because they’re all very targetable), and even re-radiation in some cases.

Thanks. I will hear both sides and make a decision, I want to avoid adt
therapy as much as possible so in my situation if I can avoid it with
radiation I would consider that as well.

Also, in my pathology report two pathologists looked at the sample and came to the same conclusion of diagnoses.

@ginger38314 With a 3+4, they don’t usually recommend ADT (unless there are other significant risk factors).

If you want to know whether or not ADT would be beneficial, get the ArteraAI prostate test. ArteraAI assesses your biopsy tissue to predict whether you will benefit from hormone therapy and estimate long-term outcomes.