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Gleason7(3+4) - treatment options recommendation

Posted by manojsmishra @manojsmishra, Aug 25, 2024

Got recently diagnosed with Gleason group 2, 7(3+4). Was in state of shock to know about the cancer.
I’m 56 year old and fortunately I’m with Mayo care since last decade.
Recommendation for me is to have prostatectomy as radiation therapy has long term implications. Took outside opinion also and same recommendation. But not sure how to deal post procedure with urge to urinate situation currently there.
Biggest thing is I’m hoping there is no recurrence occurring after this. Any suggestion/recommendation?

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cole5055 | @cole5055 | 3 days ago

I am with you! 20yr Air Force veteran
Desert Storm. When my PSA climbed to 5.1 ... 11-7-2023 the VA immediately wanted to do a trans-rectal Biopsy and remove my prostrate I said let me do some research. I felt very uncomfortable even talking with the VA Doctor! I fought with the VA to see a Urologist out side the VA for two years meanwhile my PSA continued its climb!
Finally got approved to see a Urologist and did the trans-rectal random Biopsy, I asked the Doctor what are the chances of finding anything he said 50/50 I regret doing it He also wanted to remove my prostrate After another year of MRI's & Pet-ct scans you could clearly see my Pirads 5 targets which the random Biopsy missed!
Once I turned 65 it seems the sky opened up ..... I had Medicare A&B and Tricare for life which meant I could chose everything!
The Doctor, hospital and the exact treatment I wanted "NOT WHAT THE DOCTORS SCARE YOU INTO" This year Mar 12-2026 1 got the Trans-perineal Targeted fusion Biopsy and finally found Gleason 3+4=7 one main target and one smaller target. May 19-2026 I chose Nano Knife at Mayo Clinic AZ it seemed to be the best option for my particular situation at the time of treatment my PSA climbed to 20.1.
Just had a recent PSA test it came back 2.9 and still dropping I have a follow up
August 21-2026 with Mayo hoping for another big drop. The follow up showed PSA now at 2.2 and still dropping!

The down side is the recovery 10 days wearing a catheter, & had to see the Emergency room for a second catheter for a few more days…..little to no semen…..

Ray ☝️🇺🇸✈️✅

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1 reply
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jim18 | @jim18 | 3 days ago
In reply to @cole5055 "I am with you! 20yr Air Force veteran Desert Storm. When my PSA climbed to 5.1..." + (show)
Profile picture for cole5055 @cole5055

I am with you! 20yr Air Force veteran
Desert Storm. When my PSA climbed to 5.1 ... 11-7-2023 the VA immediately wanted to do a trans-rectal Biopsy and remove my prostrate I said let me do some research. I felt very uncomfortable even talking with the VA Doctor! I fought with the VA to see a Urologist out side the VA for two years meanwhile my PSA continued its climb!
Finally got approved to see a Urologist and did the trans-rectal random Biopsy, I asked the Doctor what are the chances of finding anything he said 50/50 I regret doing it He also wanted to remove my prostrate After another year of MRI's & Pet-ct scans you could clearly see my Pirads 5 targets which the random Biopsy missed!
Once I turned 65 it seems the sky opened up ..... I had Medicare A&B and Tricare for life which meant I could chose everything!
The Doctor, hospital and the exact treatment I wanted "NOT WHAT THE DOCTORS SCARE YOU INTO" This year Mar 12-2026 1 got the Trans-perineal Targeted fusion Biopsy and finally found Gleason 3+4=7 one main target and one smaller target. May 19-2026 I chose Nano Knife at Mayo Clinic AZ it seemed to be the best option for my particular situation at the time of treatment my PSA climbed to 20.1.
Just had a recent PSA test it came back 2.9 and still dropping I have a follow up
August 21-2026 with Mayo hoping for another big drop. The follow up showed PSA now at 2.2 and still dropping!

The down side is the recovery 10 days wearing a catheter, & had to see the Emergency room for a second catheter for a few more days…..little to no semen…..

Ray ☝️🇺🇸✈️✅

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@cole5055 Little to no ejaculation happens with all prostate treatments. Catheter all treatments except radiation. You are doing good.

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Setters and Birds | @jonathanack | 3 days ago
In reply to @johnnyz "@jonathanack hi Jonathon, thanks for your story. Do you know what PiRad rating each of your..." + (show)
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@jonathanack hi Jonathon, thanks for your story. Do you know what PiRad rating each of your tumours were? I have a 1.0 which is pirads3, and a 1.9 pirads 5. The larger one is pushing on my AFS and my cause future issues around the bladder neck during treatment to reconnect is surgery. If I do radiation, then they would have to do significant beam radiation to get that large tumour which may cause post surgery scare tissue issues.
My RO says the SBRT 5 sessions is all that is needed without ADT. Sort of “yay” for me if I do radiation. Still not sure as he is not doing a spacer but is mapping the area with gold seeds to improve accuracy and minimize margins. That all said, my potential robotics surgeon is very experienced and should be master skilled at nerve sparing. Will have to wait to hear his concerns if any about the larger one is tumour being so close to the bladder neck… I see the RARP surgeon next week. BTW - my PSA has been hovering around 10-13

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@johnnyz
My pi-rads score was 4 for both the cribriform tumors. One of them was an existing tumor from my initial diagnosis at age 62 that had been a gleason 6 and moved to a 7 with cribriform. The other cribriform tumor, also a pi-rads 4 score, was new and on the very edge of my prostate. My PSA never went above 4.2 throughout my Active Surveillance timeline and my SBRT timeline. My surgeon that referred me to Dr. David Byun (radiologist - MSK/Cornell Weil) immediately. Dr. Joseph Wagner (Wagner was an early daVinci adopter with over 4k surgeries). I fully expected Wagner to recommend a prostatectomy. However, he was very clear in saying that with my circumstances that radiation would be equipoise, and surgery would likely require longer recover and potentially lifelong changes.

SBRT was not much of anything (fiducial markers were used) - some discomfort that was tolerable, some fatigue. Orgovyx was not all that bad either with the same issues and some hot flashes (very low libido).

For me it came down to the risk of incontinence for long (or lifelong) periods and intimacy (I am 64 with no issues) and that surgery was not a better option (confirmed 3 times over by Smilo, MSK, Tufts surgeons and radiologists). That said, I know of many people that want it out and that is a very good option as well, but wasn't my choice. I am all be back to normal now and realize things may change and have talked about that very candidly with Dr. Byun and have plans tentatively in place should they be needed.

Please let me know if you have other questions. Happy to help. We are very lucky to have this type of cancer at our age and not what I see children and other younger people deal with. Good luck to you and you will make the right choice for you.

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johnnyz | @johnnyz | 3 days ago
In reply to @jonathanack "@johnnyz My pi-rads score was 4 for both the cribriform tumors. One of them was an..." + (show)
Profile picture for Setters and Birds @jonathanack

@johnnyz
My pi-rads score was 4 for both the cribriform tumors. One of them was an existing tumor from my initial diagnosis at age 62 that had been a gleason 6 and moved to a 7 with cribriform. The other cribriform tumor, also a pi-rads 4 score, was new and on the very edge of my prostate. My PSA never went above 4.2 throughout my Active Surveillance timeline and my SBRT timeline. My surgeon that referred me to Dr. David Byun (radiologist - MSK/Cornell Weil) immediately. Dr. Joseph Wagner (Wagner was an early daVinci adopter with over 4k surgeries). I fully expected Wagner to recommend a prostatectomy. However, he was very clear in saying that with my circumstances that radiation would be equipoise, and surgery would likely require longer recover and potentially lifelong changes.

SBRT was not much of anything (fiducial markers were used) - some discomfort that was tolerable, some fatigue. Orgovyx was not all that bad either with the same issues and some hot flashes (very low libido).

For me it came down to the risk of incontinence for long (or lifelong) periods and intimacy (I am 64 with no issues) and that surgery was not a better option (confirmed 3 times over by Smilo, MSK, Tufts surgeons and radiologists). That said, I know of many people that want it out and that is a very good option as well, but wasn't my choice. I am all be back to normal now and realize things may change and have talked about that very candidly with Dr. Byun and have plans tentatively in place should they be needed.

Please let me know if you have other questions. Happy to help. We are very lucky to have this type of cancer at our age and not what I see children and other younger people deal with. Good luck to you and you will make the right choice for you.

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@jonathanack @jonathanack thanks again Jonathan, ya it’s not easy to decide as the cribriform scares my wife more than me… None of the doctors who I asked specifically about the cribriform say that it does not impact thier treatment decision. On Sept 24 I meet the robotics surgeon and will weigh what he says. My previous surgeon who did my pathology follow-up in July said there is no difference to cure between radiation SBRT 5 sessions over 2 weeks, compared to RARP. I have worry about future recurrence and impacts of radiation as my treatment now causing future urination issues. I will get treatment still 68 years old and hopefully have many years to live and want to enjoy a life going forward. I do wonder about my longevity for living old regardless since my parents died at 69 and 74 years old. Seems that radiation has better post treatment 5-8 years before impacts set in. For sure I don’t want bowl and waking up at night to urinate etc. so, “cure” chances are equal for both treatments, and pay now or pay later for quality of life impacts… much to ponder in the next few weeks. I will decide on treatment shortly after my RP consult…

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