Gleason Grade 2

Good to hear you’re getting a second opinion. With such a low intensity case of prostate cancer, you do have a lot more options than surgery.

You could have radiation or you could pursue one of these treatments, HIFU , Cryoabalation , NanoKnife , TULSA PRO, HoLEP, Which can eliminate the cancer without surgery or radiation? This allows, you to then have radiation in the future, Or even surgery if possible.

You could do active surveillance with the low 3+4 Gleason, But you should get blood tests no less than every three months to see if your PSA starts rising again.

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.

Hi,
I was diagnosed with prostate ca 6 years ago. All my biopsies came back Gleason 6 so opted for active surveillance. MRI however showed pirads 5 which is considered highly indicative of a more aggressive cancer. Last year my biopsy showed cancer was invading my urethra in the prostate and opted for surgery. Right up until before my surgery the biopsy showed Gleason 6. The pathology of the prostate taken out turned out to be Gleason 7. Honestly active surveillance is risky. The only reason more men don’t die of prostate cancer is because its grows slowly.

I agree, if we knew better my husband would have Cryo or similar as soon as 3+3 was discovered. Our AS failed big time 🙁

You are going to the right place for another opinion - surgery seems extreme as your only option at this point. Sloan does focal therapy so you have plenty of choices. Best,
Phil

Good you are getting a second opinion and you now have more info (from Jeff mar) to ask about other more targeted treatments. I went with TULSA PRO last July. I liked the technology and precision but what sold me was how much less invasive, less risky (side effects), and the fact that all other treatments were still on the table if cancer returns. I did end up having it done at Mayo Rochester after getting 7 doctors opinions. At 9 months all looks good. There are many threads on this forum that can provide more info on some of the newer targeted treatments. Click on my profile to see my experience. Good luck.

@pv001
I had 3+4 gleason as well. I had a Decipher test (from the biopsy material) which does help doctors decide on treatment regimens.

My choice was to take care of it right away because even with blood tests every 3 months, there are no guarantees on tumor growth and every body is different. I also felt that if growth occurred outside of the prostate during the 3 months, I would be prescribed a more aggressive regimen with more side effects.

I had the Mridian radiation machine that has a built in MRI so what they see in real time, they can treat and the margins are smaller than other radiation machines so the side effects and toxicity are less. Here is a link to the Urology Times article talking about that randomized trial study:
https://www.urologytimes.com/view/mirage-trial-margin-reduction-with-mri-guided-sbrt-reduces-toxicity-vs-ct-guided-sbrt

Unfortunately for all of us we can't know what the right path is with certainty. Getting a 2nd opinion is definitely the right next step. You can even go for a 3rd if you still have concerns and questions.

I've been on Active Surveillance for eight years and it has so far worked for me, but can't say why it's worked outside I've just been lucky. In my case my 3+3 was just one core and on my 3rd biopsy my 3+4 was also just one core.

As mentioned you do have a 3rd choice and that's some form of focal therapy; i.e. something that will target part of the prostate and not go for the entire prostate.

As you learn more, come back here and ask questions. There's a great group here and I've definitely learned the most about prostate cancer by reading what others have posted here.

Try not to let anxiety get the best of you, but that's usually easier said than done. But know that we all fight that as well.

We are all hoping the best for you.

"How can you trust Active Surveillance?" --> by keeping it "Active".

In addition to regularly scheduled PSA tests every 3-6 months, track your:
> % Free PSA
> PSA Density
> PSA Doubling Time
Look for any other issues that may have been mentioned in your MRI report and biopsy report.
Also, get a biomarker (genomic) test and a genetic (germline) test.
Some centers do periodic MRIs every couple of years to look for any changes (and if there are, then a repeat biopsy to see). Others (like myself) had repeat biopsies every few years.

(If you do choose active surveillance, keep the surveillance "active" and use that time wisely. Initially, at age 56y with a localized, 6(3+3), PSA of 4.2, I was on active surveillance for about 9 years. When my PSA continued to rise, my Gleason eventually hit 7, and a biomarker (genomic) test indicated that I had "exceeded the threshold for active surveillance," that was my cue to get treated. During the last part of those 9 years on active surveillance, I spent 4 years diving into the details of each treatment option - surgery, focal, internal radiation, external radiation. So, when it was time to get treated, I had already chosen proton beam radiation as my preferred option. That was in April-May 2021. These days, my PSA varies between 0.35-0.55; my most recent PSA was 0.47.)