Biopsy 1 carcinoma found.

@hibernianstpat
You are going to get a lot of options on treatments. If you do not then seek a different opinion. I had same Gleason Score and surgery was discussed but not proposed, photon radiation with hormone treatment, then proton treatment with no hormone.

I don't want to imply your score of 7 from a 3+4 is anything to not be concerned with but you will probably here form your doctors a lot of treatment options at that Gleason score.

I did not have surgery and did not want surgery. I was advised of surgery but since I have heart failure and have a ICD/Pacemaker it was per my R/O and urologist not something they wanted to recommend with my Gleason Score.

Here are some suggestion based on my experience with this. A urologist is most like pro surgery. Ask to be brief on the pros and cons of all treatments for you specifically, surgery, photon radiation, proton radiation, hormone treatments. Then do your own research.

Again from my experience my Mayo R/O were good and recommended additional test beyond my Gleason Score. I had a Decipher test which came back low risk versus intermediate risk I was given after biopsies. This changed my treatment plan from radiation with hormone to radiation only.

Asked for a Decipher test, PSMA, bone scan or at least discuss them with your urologist. I think most of us based on our experience would suggest like we did to get second opinions.

I can only pass on (I was 76 when diagnosed with cancer) what my experience was but making sure you get in depth briefing on all options for treatments, do your own research. and consider doing a second opinion. You are at the start of your journey with prostate cancer and you are going to have many many more questions. Just remember it is your cancer, your body, your mental health, your medical history so it should be specific of what is best for you not what others did.

What you need to find out is what is the percentage of 4 found in the one core that had a Gleason seven. Also, what percentage of that core had 3 and 4.

If you come up to something like 5% or 10% of the core with a 4, you could actually go into active surveillance and not do anything yet. Your doctor may recommend this if it’s a very low percentage.

I agree with @jc76 , use your biopsy material to get a decipher test. It is used by doctors for treatment adjustments.

I had 3+4 Gleason with low risk decipher, did my research and chose a radiation machine that had a built in mri vs others with fused images. Side effects and quality of life was my priority so the less healthy tissue exposed, the less potential side effects. Treated in February 2023 with 5 sessions. Urination restriction after 3rd treatment. Flomax took care of it.

ProsTox (Miradx) has a test to determine if there is a 15% chance (vs,5%) of delayed urinary tract symptoms. This is not acute post treatment side effects which appear to be the same and resolve over a similar time span. The test is for those considering SBRT or IMRT. Being experimental it may not be covered by insurance. The SBRT costs $500., whereas both costs $900. [Spring 2025]

I believe there are other therapeutic options beside radiation. Consider watching relevant You-Tube videos produced by PCRI.org which is at arm's length from your treatment choices and is based on almost 30 years of experience by a medical oncologist who limited his practice to the prostate.

If further reassurance would help in the decision process consider having your slides viewed by AlterraAI (sp?)

BTW: It is thought that there is a 20% difference in biopsy slide trained human visual interpretation. If viewed by a second source knowledgeable of the first score
they often come back to the referral source with a higher Gleason. Which one do you pick, [Not to be too cynical should you then check with a third which is ignorant of the previous two opinion?]

AlerraAI uses artificial intelligence that relies on deep computer learning to view over 10,000 cases who had received standard treatment based on I assume the last Gleason metastatic risk category provided by the referral source. I assume that incorporating PSMA PET scan refinement of metastasis risk and treatment
was not available so soon after general adoption post Medicare/ insurance approval two+ years ago

I had proton radiation in 2022, Pet/psma showed all cancer gone in prostate nothing lit up I had dual tumors and Gleason 8 PSA at time of radiation 12. Absolutely no side effects from the proton radiation. PSA 3-
months after treatment was .47

Your situation is very similar to mine, right down to the low risk DECIPHER ue and no ADT, except my Gleason was 9, and no heart issue. I had proton radiation, based on its lower side effect profile than photon (X-rays).

No ADT was a choice - it was part of a clinical trial protocol if I wanted to join, or otherwise I would have it. I spent a lot of time and research before deciding against ADT. My Mayo PCP strongly agreed, BTW. But that issue is complex, and the clinical trial is to find out if, for high risk PC (Gleason 8+), risk stratification could advise amount and type of ADT, including none for the lowest risk group. So my decision is personal, and not a recommendation either way.

I also consulted with both Mayo radiation oncologist (Mayo R/O) and also a Mayo urologist who would do the surgery if we decided to do so. He was unequivocal: I was not a good candidate for surgery and shouldn't want it, so I went with radiation.

A comment on that from a *non expert* (me): surgery fixes things quickly, but with certain near term morbidity (or even, unlikely, death), and the risk of permanent side effects, depending on one's condition and luck. After surgery, if the cancer was confined to the prostate, it's gone (barring undetectable metastases).

Radiation takes some time, tests and one surgery for preparation (at least it does for proton, not sure how much for photon), and then 5-28 days of painless treatment. I had 28 days - usually 40 minutes from arrival to departure, with parking reserved for radiation oncology patients being treated - Mayo Phoenix. The one surgery was under anesthesia and painless - they use needles in two spots to implant x-ray bright markers in the prostate, and a radiation shield material under the prostate. I think mine took 45 minutes total.

But, the cancer takes some time to die after the radiation, and the prostate likely has cells dying for awhile. I don't know the details on all that, but PSA is not going to drop to extremely low for a long time if ever, even with successful results. The PSA trajectory is a complex topic that I don't fully understand - I'll know more in a month after my first post-treatment PSA test and R/O consult.

Radiation can have side effects, some lasting a few weeks after the radiation, some can be permanent. Common are fatigue towards the end of the treatment, and a few weeks afterwards, and bladder irritation causing urgency. Others are possible - again, I'm no expert. I still have bladder irritation and some infrequent but embarrassing incontinence. A friend who had the same diagnosis and treatment did not experience that AFAIK.

So I recommend consulting both specialties, doing your own research if you feel like it. I did, plus spoke with a number of friends in my age group who had had either surgery or radiation, with and without recurrences.

Hope this helps.