Is anyone with Gleason 4+3=7 trying active surveillance?
I am 72, recently diagnosed with with two localized tumors, one at the right apex, another at the right base. I have a girlfriend and we have an active sex life. I've been to two centers of excellence and neither wants to do any type of focal treatment. So, I'm considering going on active surveillance, and if I die earlier death than I might otherwise experience with treatment, then so be it. I have no children or living family. I'm what the media referred to a few years ago as an "elder orphan," so my quality of life is more important to me than living a long time.
Would very much appreciate any thoughts or insights.
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I have 3+4=7 my urologist said it less then 2% of 4 in one core 25% of 3 in one another core . My urologist wanted to operate. I went to a radiologist he suggested AS- I sent the biopsy to John Hopkins they said I was a 3. I changed Urologist I went to Nebraska Med center he did a perineal biopsy no change but they graded it as a 4 and kept me on As. I am either a 3 or 4 and I have been on A S for 3 years.
I had Gleason 6 on both sides when one went Gleason 7 I had HIFU. I still have Gleason 6 on one side. I am 58. No erection or leaking problems
I am currently on AS, but only after having a year's worth of ADT with Lupron D, the last injection being May 13. My PSA is 0.1 with a testosterone level of 10, And yes, have Gleason of 4+3.
Good thoughts!
Thank you all for your thoughtful comments and support. I am currently being evaluated for possible treatment at the Kettering Cancer Center, and, have sent in my pertinent medical & imagery records for review at the Scionti Prostate Center in Florida to determine if I am a viable candidate for focal therapy.
If Scionti believes my localized tumors’ grades (one has Cribriform cells), location and size make me a viable candidate, then I will go with them; if not probably Kettering.
FWIW, 13 years ago I had a pre surgery Gleason of 3+3 and was told by Cleveland Clinic Chairman 50% of their patients with this score were on surveillance. I didn’t want to worry all the time so had the surgery and the final biopsy showed I was actually 4+3 or very much more advanced than the original biopsy indicated.
I was 4+3 and did 44 radiation and 4 mos ADT. Didn’t like it. But it was better than the pain and agony of metastasis in your bones. Started ADT in May and radiation in June. Got done in Sept. I’m almost back to normal. So the sacrifice to me was worth it. I’m considered in remission.
I could easily go 5 years or more without reoccurrence.
Catch it early and you can just keep going.
You want to catch it and treat it before it leaves the prostate.
How’s your quality of life as related to sex life, erectile function, and continence? Every doctor I’ve consulted with said radiation kills the entire prostate, and 50/50 chance of still being able to get an erection
You are right on target with your reply. Good to see someone spoke up with the gospel. Thanks!
Hey Paul, Cribriform cells do kick the grade up a notch - and those cells are aggressive; also, they do not respond well to standard radiation.
However, Sloan Kettering does have a protocol where they use high dose brachytherapy (seeds) in combo with either 5 session SBRT (Cyberknife) or 25 or more sessions of IMRT.
They would insert those seeds into the areas with cribriform cells for about 45 mins under anesthesia. Also, and I KNOW you don’t want to hear this, you would probably be placed on 6 months ADT to weaken the cells even more.
It’s not guaranteed to destroy your sex life but things will become challenging…
Phil
I chose surgery with a 4+3=7. I did not like the sound of radiation continuing to make changes to my body after treatment, so I went with the knife. Final tissue biopsy showed I had some more aggressive Gleason 5 cells, so I was glad I didn't continue the surveillance any longer. I now pray that it is all gone, but the quarterly PSA tests will be the proof of that. I would not want to be praying that my 4+3=7, with some 5 mixed in, would not be spreading throughout my body to lessen quality of life, inflict pain, and kill me.