Gleason7(3+4) - treatment options recommendation

You wrote “ Radiation has replaced surgery for most people these days. You should look into the other option.” And then suggested that he contact Dr. Mark Sholz in California.

You’ve totally dismissed Mayo Clinic as a center of excellence. Do you honestly think that the doctors specializing in treatment of prostate cancer probably at Mayo are second rate compared to other providers? Mayo sets the highest standard of care.

Stop spreading misinformation that more patients are receiving radiation as their primary treatment. Misinformation is offensive to those of us who are fighting aggressive disease and have gone through surgery after receiving that recommendation from a tumor board at a Center of Excellence.

If you want to share that you received radiation as primary treatment and that your PSA indicates cure please do so to help other men. Don’t give medical advice.

Prostate cancer is a complex disease and treatment is not a one size fits all solution. You’re not a medical expert and need to stop recommending treatment on this forum.

@davidz26
I agree that you should consider SBRT which I finished 3 months ago after a 3+4=7 Gleason. Prior to my decision, I did a decipher and ArteraAI test which were very helpful and reassuring that I was making the best choice. So far so good; minimal side effects in all areas. My initial urologist strongly recommended surgery, prompting me to find a more objective provider. Given my status, the research on surgery did not feel like a necessary or good choice. Good luck on your journey; you’re not alone.

@robertmizek just got my results

14 cores.
1 Gleason 7 4+3 70%
2 Gleason 7 3+4 10%
3 Gleason 7 3+4 10%
11 others negative

@dekestet Appreciate your reply and glad things seem to be working out for you.
I feel like focusing on surgery is primarily based on frustration but will look into this Sbrt more.
Do they use Proton or any type of spacer with you?

@charliebrowntri7
You definitely need to look into treatment. The 4+3 with 70% is something that needs to be
treated?.

Are the 3+4 and 4+3 close together? If they are, it’s possible you could have focal therapy.

Five sessions of SBRT radiation would probably work quite well.

How large is your Prostate? How old are you? How high was your PSA?

All factors in the decision you make.

I was 64 when treated (diagnosed at 62 and then developed additional tumors): 6 tumors - 2 are gleason 7 with cribribform (3+4) and 4 are gleason 6. Bi-lateral. I had a decipher score of .72. I would advise a decipher score very strongly before opting for Active Surveillance.
I had 3 consultations with referrals from my urologist/oncologist Hartford Health Tallwood's - Joseph Wagner - pioneering robotic surgeon 4k successful. Dr. Wagner set up consultations with Smilo Yale/ MSK/ and Tufts). I met with urology surgeons and radiologists from all and each advised exactly the same thing: surgery vs. SBRT were equal in treatment and cure for my situation (contained - with cribriform). There are good backup options beyond salvage prostatectomy if something fails.
I opted for SBRT with Dr. David Byun (MSK/Weil/HHC referred by Dr. Wagner). The radiation was nothing - 5 sessions - and ADT/orgovyx was entirely tolerable (30 days pre-treatment and 90 days post treatment. Not fun - but tolerable. Fatigue was the primary side effect along with some temporary urgency to pee. 9 months after treatment everything is all but 100% normal and functional. No meaningful side effects. Exercise, as advised by many people on this blog - Jeff Marci, Heavy Phil to name two that helped me a lot, was/is very helpful for me. Jeff and Phil among others are very knowledgeable and helpful re: articles, research, and conference(s) updates. I also spent considerable time on this blog, True North, Dr. Scholz (you tube), and my primary care doctor. The deciding factor for me was the risk of being incontinent via surgery and intimacy restrictions and that both viable options were curative. The radiation and ADT had almost no meaningful side effects either during treatment and my function now is as it has always been.
Good luck with your decision - it's a tough hand to be dealt to anyone with cancer, but we (older with treatable issues) are so much luckier than the kids, young parents, etc. that have a much tougher road. It will work out.

@ireland1964
You definitely want the rectal spacer gel (SpaceOar) for protection and fiduciary makers for targeting the lesion. They were done at the same appointment. The radiation was standard for the field. Also,make sure your urologist is certified and experienced with the spacer gel which isn’t a given. Best of luck.

@dekestet I am not sure why, but here in Ontario Canada, they don’t use rectal spacers?

@dekestet I am not sure why, but here in Ontario Canada, they don’t use rectal spacers?

@jeffmarc thank you. I’m 65. Prostate is 40. PSA 5.4. All scored as grade 2.