Gleason 3+4 A.S. or treatment?

You have quite a few cores positive and with some some Gleason 4, even at only 5%, I would seek the exact treatment you mentioned, SBRT. You should also look at getting a Decipher score as well. If you were unlucky on that with a high score as I was (0.81) with my 3+4 case, you might even need some ADT. But most likely ADT will not be needed. See my bio for more details.

There are two different drugs that help with urgency. I used to get up at least twice a night and I now don’t have to get up at all, Pee a little bit after I wake up.

I take Myrbetriq Twice a day and it helps with urgency and incontinence. Another pill that does the same thing is Gemtesa. You might ask your urologist to allow you to try one of those two drugs.

@wwsmith . My decipher and Artera scores were both low, so probably no ADT for me. I do appreciate your feedback!

Mike

@jeffmarc

Thanks Jeff, i'll discuss with my oncologist next visit.

I was 65y (in 2021) with a similar diagnosis as you - 7(3+4), localized, PSA of 7.976.

With similar options as you, I chose 28 sessions of proton radiation. (Look up the Bragg-Peak characteristics of proton radiation.)

My PSA now hovers in the range of 0.3-0.5.

@higgins56 Awesome! 5 sessions of SBRT and no ADT will be an easy ride for you with very low odds of recurrence.

At 69 in 2022 I had 3+4. Decipher was low risk PSA was 10.2 with slight urination issues. Cancer was confined to the Prostate.
After looking at removal, Proton and other radiation types, and the machines, I chose the Mridian radiation machine, SBRT, for 5 treatments with no ADT. Its close machine equivalent is the Elekta Unity. Both these machines have built in MRI vs fused images. What the doctor could see, he could treat and the built in MRI reduced the exposed healthy tissue margins to 2 mm vs 3-5 mm for proton and other forms of radiation. That meant less side effects and better quality of life per the Mirage study (https://www.urologytimes.com/view/mirage-trial-margin-reduction-with-mri-guided-sbrt-reduces-toxicity-vs-ct-guided-sbrt). The built in MRI was a big deal in my decision process.
So far so good. I did have urination restrictions after the 3rd treatment but for me, Flomax worked but maybe @jeffmarc suggestions could work. So far so good. Treatment was finished in February of 2023.

@higgins56
I see one poster mentioned to consider Decipher but from your post you did have it and came back low risk.

Your diagnosis almost mirrors mine. I was never though given the option to just have A.S. I was diagnosed at Mayo Jacksonville but at the time only had Photon SBRT. The treatment there was 20 rounds of photon radiation and not hormone.

I got second opinion at UFHPTI as they had proton and they had same diagnosis and treatment plan radiation (but proton) and not hormone treatments.

If me would asked your medical doctors about why the think A.S. is okay. Also do you have access to a medical institutions that does proton radiation? If so explore the difference and pros and cons of proton over photon.

Also considering getting a second opinion if you are in doubt as can really help you make decisions.

Quick Question. Do you know what the conditions are to be a candidate for SBRT? Also you mentioned the transperineal biopsy. What was that like compared to the Trus biopsy? If you were to stay on AS at what point would that decision change and you would seek treatment?

@ezupcic
If the cancer was isolated to the prostate, The Gleason score is not too high, Then SBRT is a good decision. My brother had it done at 77 with the Gleason score of 4+3.

ATRUS biopsy is transrectal not transperennial. Has a higher risk of infection.

You can have the same ultrasound guided Biopsy that is transperennial. I read a couple of days ago that’s the only thing Mayo does now.

As to when to stop AS, There’s a lot of factors involved. Are you only Gleason 3+3? If 3+4 is it a very small percentage of four? You could probably get a better feel for what the answer is by watching these videos.

Here is a video with Dr. Laurence Klotz, one of the experts on active surveillance. He can give you answers as to why you would or would not be a good candidate for active surveillance.