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Gleason 3+4, How did you treat?

Posted by keithl56 @keithl56, Jul 10 6:39am

Just got my pathology report back and have a Gleason score of 3+4 (ironically on the opposite side of the targeted lesion).

I'm interested in hearing how others treated this. I know that there are a ton of variables beyond the Gleason score (age, comorbidities, quality of life concerns). In my case I'm 70 with CAD.

Thanks in advance!
Keith

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jim18 | @jim18 | Jul 12 4:08pm
In reply to @keithl56 "@surftohealth88 You sound like my wife! Everytime I bring up AS she pushes for RARP, citing..." + (show)
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@surftohealth88
You sound like my wife! Everytime I bring up AS she pushes for RARP, citing the same logic as you. She of course will be accompanying me to see the surgeon who has already indicated that RARP is likely the best route. This is a daunting journey.

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@keithl56 There is natural bias to recommend what you know so surgeons will recommend RARP even if they perform it poorly and will believe it is the best even when it is not. As far as ADT it probably does more damage than good for 3+4 local disease but is essential for metastatic disease. For AS: Did you get a decipher test? What is the doubling rate of your PSA? Those are among the factors that indicate how aggressive your disease is.

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keithl56 | @keithl56 | Jul 12 4:52pm
In reply to @wheel1 "@keithl56 I would add if your health is up to surgery now, that is something to..." + (show)
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@keithl56

I would add if your health is up to surgery now, that is something to consider, as health can turn on a dime and you might not be able health wise to have surgery in a year or two when you need it as I mentioned earlier most surgeons cut off at 75 and earlier for health reasons. That is if you want surgery, as very good radiation options regardless as you get older. I will say I had my surgery at your age and feel my quality of life is outstanding. I know the old bird in hand two in the bush. Your arguments support AS and AS will definitely allow your continued quality of life without much of a gamble prostate cancer wise if aggressively monitored. For me at your age it would be the dice throw for continued good health until going off AS. I might be biased regarding health issues as I have been through several always never expected. Discuss with your surgeon the pro and cons. Right now you are in the drivers seat and have time to make that decision.

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@wheel1

I know, so many variables. I will definitely involve my cardiologist and neurologist in my decision making process to get their input.

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keithl56 | @keithl56 | Jul 12 5:00pm
In reply to @jim18 "@keithl56 There is natural bias to recommend what you know so surgeons will recommend RARP even..." + (show)
Profile picture for jim18 @jim18

@keithl56 There is natural bias to recommend what you know so surgeons will recommend RARP even if they perform it poorly and will believe it is the best even when it is not. As far as ADT it probably does more damage than good for 3+4 local disease but is essential for metastatic disease. For AS: Did you get a decipher test? What is the doubling rate of your PSA? Those are among the factors that indicate how aggressive your disease is.

Jump to this post

@jim18

I'm going to request Decipher when I meet with the surgeon. My PSA doubled in one year prompting this whole mess.

My surgeon at JH appears to be competent. His academic credentials are really good but I need to press him on how many surgeries he has under his belt and if he has data on ED and incontinence effects on his patients. He is currently running a clinical trial with aquablation, so he seems on top of new technologies.

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surftohealth88 | @surftohealth88 | Jul 12 7:17pm
In reply to @keithl56 "@surftohealth88 Thanks for the valuable input. If my surgeon agrees and I decide to go the..." + (show)
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@surftohealth88

Thanks for the valuable input. If my surgeon agrees and I decide to go the AS route I plan on being very proactive in frequent testing to catch anything if my cancer progresses. I figure that if I can have a couple of years of quality of life then go through the same process as I would now, with favorable results, that may be worth it. However, the majority of the feedback that I have been getting says to get the damn thing out now. The factors that are influencing me to consider AS are:

Grade 2, favorable intermediate risk, 3+4
Low PSA - 3.9
Low PSA density <0,15
Only 10% of my 3+4 was 4 (usually under 20% is acceptable
Only 2 cores of 16 tested positive

So, I have to decide whether to throw the dice or play it safe (maybe)

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@keithl56
Great but keep in mind that aggressive cancer usually produces less PSA than indolent one. My husband had zero indication that anything is brewing. His PSA before surgery was 5.6 and during SA going from 3 to 4 to 3 to 4 to 5 (up and down). The first biopsy 6 years ago had only one 3+3 and one possible 3+3, genetic test showed "low risk to develop significant cancer in 30 years". He had MRI every year but no new biopsy in 6 years. In 2024 second lesion appeared but the first one SHRUNK ! PSA still 4.8 . In 2025 biopsy was done since his PSA rose to 7 (but than fell down to 5.2). Out of 16 cores only one was 4+3, two 3+3 all the rest NOTHING. Even when his gland was out the tumor total was less than 10% of a whole gland and only one spot in that 10% with 4+5 !!! Did not make any difference - it was enough to cause cancer escaping ! So from 3+3 single core to 4+5 and node involvement in 5 years : (((. If we knew all that we know now, my husband would have had RP at 3+3 . He recovered fully and in record time - zero effect on quality of living. And let me tell you , both of us would take ED and incontinence over this situation that we are in now - ANY DAY ! There is NO worse side effect than having aggressive cancer, but we are all different.

Wishing you super successful SA and super successful treatment whenever you choose to have it.🍀: )))

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