Decision to be made on treatment

Welcome to the forum and welcome to the club that no one wants to join. I was a Gleason 8 4+4 type 4 High Risk aggressive when Diagnosed. Your next steps will likely be a PSMA to see if you have spread and an MRI. Once those are completed you will have options. In my case I had no spread and since my Cancer was confined to the Prostate I decided on removal of the Prostate via Robotic surgery. I'm about a month away from my Post Op PSA test to see next steps. I'm certain you will get a lot of responses to your question.

This is a great forum and everyone here has a different perspective. 🙂

Definitely need more information. 3+4 may mean you could go on active surveillance. It could also mean you need to have it treated right away. The answer to that depends on what your biopsy shows. What percentage of cancer was there in the cores that were positive? What percentage of 4 was there in each of the cores.

How many cores were taken and how many had 3+4? Any 3+3? Was there anything else found in the biopsy? Cribriform, Seminal vesicle invasion, EPE or other things.

Posting your biopsy here would really help get you more information it will give you a better clue as to what treatment might be.

@jeffhdgsn
Regretfully welcome to our club.

You are at the very start of your journey. You are going to be hit with some many different points of view, and if you do research a ton of information on prostate cancer. My advise is to remember do what is best for you. If you have experienced urologist and medical experts that you are seeing seek out their opinions and then if you are not sure get second or third opinions. Many times you can just sent your medical records to major medical institutions like Mayo or Cleveland clinic who can do second opinions.

I had the same biopsy Gleason Score you did 3+4=7. Did they give you a low risk, intermediate risk, high risk?

When you are getting more information try to remember there are some very good tests out there that more accurately defince diagnosis. A Gleason Score is subjective of the pathologist or urologist reading it. I suggest and many others will mentioned getting a Decipher test. It is a more precise test not subjective to determine if your cancer is low risk, intermediate, or high risk.

Having a Decipher test will help your medical providers and you decide on your treatments and options. Remember it is your body and your decisions so what another chose to do may not be what is best for you. There are other test called PSMA and bone scans that can also help define is cancer is still within prostate.

Just be prepared to hear a lot of information, terms, different opinions and just tons of information coming at you. If you trust your medical providers then lean on them to guide you and explain. If you are in doubt get second opinions from major medical instutions.

Good luck you have long way to go on what is going to be best for you. Just remember us on MCC are here to give you our experience with prostate cancer and inspiration not medical guidance of what to do or not do. That decision is up to you and your medical providers.

Thanks for your message. I meet with the doctor on Friday to discuss next
steps. Like you said, there's a lot of info out there.

Decipher test, PSMA PET before you do anything.

A very large percentage of doctors advise RP or radiation because they don't know anything else. There are other treatments, Tulsa pro for example which was greatly improved on mid 2023 and is now a very good option. If I can do Tulsa so can you, you just have to take the local docs opinions and move on to a doctor that will give you more than the standard two options which should be your last choices unless things are spread or metastatic or outside prostate in any way. Options should be stay on AS as long as one can, then Tulsa Pro (maybe hifu in a few cases, and maybe a new one called vanquish), then as a last resort RP or radiation.

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Tulsa
https://tulsaprocedure.com/find-a-tulsa-pro-center/
https://tulsaprocedure.com/

Like others in this thread, I wish you well with the journey and second the view that there are several options to consider at each stage. By way of illustration, here's a summary of my experience working with the oncology team at Johns Hopkins
- late 2016 (66 years old) - rising PSA, biopsy Gleason 7 4+3. Radical Robotic Prostatectomy.
- early 2017 - PSA rising again after surgery. The radiation oncologist considered salvage radiation but recommended experimental PSMA imaging. The test revealed widespread involvement of the lymph system, but tumors were below the detection level for the CT scan.
- Referred to a medical oncologist to start hormone treatment with Eligard. This suppressed PSA for about 2 years, but the effectiveness eventually declined. Two visible tumors appeared on the shoulder (lymph node) and jaw (bone).
- Oncologist added abiraterone + prednisone to the Eligard. This worked for another year, visible tumors disappeared.
- Eighteen months later, abiraterone lost effectiveness. The oncologist enrolled me in the STEPUP research study that combined enzalutamide and high-dose testosterone on a rotating schedule. PSA levels were reduced for about 18 months.
- In April of this year, the research protocol lost its effectiveness, and PSA levels increased substantially.
- In early August, I will begin Pluvicto radiation treatment. This method uses PSMA to target radiation directly to cancer cells rather than for imaging (see above). Six injections will be given six weeks apart, with continuation of Eligard.
Throughout this period, side effects have been similar: fatigue, some brain fog, decline in muscle tone, ED. But I've largely been able to enjoy life as a retiree with my wife, kids, grandkids, and involvement in some nonprofit organizations. Until now, we traveled frequently, mostly to Italy and to Pittsburgh and Cincinnati, where our kids and grandkids live. All the best to all of you!