Biopsy results, seeing urologist on (6/9/23)

I think that Gleason 7 deserves more than observation but maybe not radiation or surgery yet but at least meds ie ADT. If they do a surgery it is possible that they would see more than a 7 and give it an 8 gleason score so some action is probably required by nothing is urgent at this time Good Luck

What is your age? How is your overall health?

Rpeecher: I had 3+4 = 7 Gleason as well. I did not want to take the chance that it would grow into something worse (Dr’s have no way of really knowing when the spread will go too far) and would force me into other choices that involved, chemotherapy, hormone therapy and radiation. I felt that catching it early on was very important, and it sounds as if that has happened to you. Everyone reacts differently of course, but my brother took adt in addition to radiation treatment for prostate cancer. The adt was very unpleasant for him. His prostate cancer was also outside the prostate.

You can use your biopsy material, which is good for up to a year, to take the Decipher test, which doctors use to judge aggressiveness of the cancer. I then re-searched both prostate removal and radiation. I decided on radiation and researched, radiation machines, and those machines that had the most accuracy and that minimized exposure to healthy tissue as quality of life and the after effects of treatment were important to me. I narrowed it down to Mevian’s Proton Therapy or the Viewray Mridian, Linac machine (viewray.com). I chose the Mridian because all of the Radiation choices used 3 mm to 6 mm of exposure to healthy tissue while the Mridian used two millimeters. It also has a built in MRI, (as opposed to fusing images together) and shuts off automatically if the machine detects the radiation going outside the mapped area. The Mirage randomized trial study showed the effectiveness of this machine.

I had Spaceoar inserted about a week before my treatment, which separated by 1/2 inch my rectum from my prostate to avoid exposure. I had five radiation treatments, which ended February of this year. I spoke to five radiation oncologists, four of them from centers of excellence, to come to my decision.

My psa started at 10.2 and after my treatment, over the last 4 months, I have had two blood tests. My psa was 4.61 and then a week ago 2.99 so headed in the right direction. Some minor urinary issues in the beginning which were taken care of by Flomax. No blood or pain.

If you can, get more than one opinion and do so outside of the Kaiser environment.

I’m 68 very good health mt. Bike, workout 4/5 days a week. Also do a lot of dirt biking

I was on active surveillance for 8 years. 3 biopsies all said 3+3 tumor. PSA kept rising so decided to do the surgery. Pathology report said Gleason 3+5. Even an MRI guided biopsy missed the worst of my cancer.

Echo other comments above: I believe in treatment.
Surgery or radiation/ADT.
RP age 72. Still needed salvage radiation and short tern ADT, but would do it again for a chance at surgical "cure".
Surgery will keep you off the bike for a while; do not know about radiation and biking.
Best wishes for a good result whatever you decide.

Don’t feel rushed to start treatment. Prostate cancer is the slowest growing types of cancer. The 15-year survival rate for men with localized prostate cancer is 94%! Take time to make the best treatment choice for you. Working with your physicians, there is plenty of time to make educated decisions.

I've got Kaiser in Nor Cal. Diagnosed G7 (4+3). I've got some opinions on Kaiser...
The advice on this and other forums is invaluable. Youtube can be your friend as you educate yourself. Check out the PCRI channel. Work your way through the search engine and ask specific questions here. Men here, and their wives, will give you personal stories and what to actually expect that drs, in my experience, gloss over or completely ignore. Research the genetic tests available. Some are very expensive but can be treatment changing. Get a second opinion at Johns Hopkins by Dr. Epstein; he may downgrade or upgrade your biopsy results. He's the go to guy and you will pay out of pocket but it should be your next first step.
There are many treatment options out there and it will take some time to educate yourself but after a month or so, it will make more sense. As I believe Dr. Scholz said, it's like the wild, wild west out there.
If you have any specific questions, message me. I've had phone calls with many guys here and they've all been helpful. Don't hesitate. Take care.

You don't mention your age. If you go for radiation it matters as some studies show that ADT for men over 70 with localized prostate cancer it makes no difference in OS or BCR. The oncologists won't tell you this you must do your own research. If I were you I would get a PSMA Pet scan done to see if it has spread anywhere other than the prostate. I had it done at Mayo Phoenix, and it was a relief to know it was confined to the gland only. I had 2 cores that were a 4-3 Gleason and 3 that were 3-4 which put me in the unfavorable intermediate risk group. My problem in making a decision was my PSA was only 2.9 and only 5 cores were positive for cancer out of 30. The reason for 30 cores is that I have a 120 gm prostate. All the cancerous cores were from the area of the lesion that showed up on the MRI. The biopsy was a fusion guide transperineal biopsy. I did do the 5 radiation proton treatment at Mayo Phoenix.

You should also check out pcf.org. They are another good source as well as Dr. Scholz' pcri.org.

I just finished PC radiation at Kaiser Nor Cal, specifically the Dublin RO clinic, in April. Aside from the 20 mile trek to Dublin each day, my experiences with them were actually pretty good. If you want to PM me here, I can give you a little more detail on my treatment regimen there. I get my after-treatment PSA check at the end of the month, but I'm optimistic for good results.