My husband has Gleason score 3 + 4 = 7 (Grade Group 2 Perineural Inva?

Depends on the details of the Biopsy and your husband’s age. But 3+4 is called favorable for a reason, so no need to panic. He might be a candidate for active surveillance, focal treatment, radiation, or surgery; all depending on the number of cores positive, volume of cancerous tissue in each core, presence of other high-risk features (cribriform, IDC), and imaging results.

In either case, you would want to get a second opinion on the biopsy reading and also on treatment with a couple of urologists, radiologists, and oncologists. You also want to get a Decipher score to inform your decision.

The sounds real good. With a 3+4 and only PNI there’s not much future risk once treatment has been done, Hopefully the doctor told you about all the things found in the biopsy.

How many cores We’re taking in the biopsy and how many had cancer. What percentage of cancer did they have? What percentage of the cancer was a four.

These are all important questions to ask your doctor so you know more about what’s going on. It’s possible you could just go on active surveillance if there’s a very low percentage of cancer and a very low percentage of 4.

If this requires treatment, you could pick Surgery or radiation or Non radiation treatments like HIFU, Cryoabalation , NanoKnife , TULSA PRO, HoLEP.

Many people in this forum had Tulsa pro and has worked well for them.

You want to at least talk to more than one doctor about your treatment. You may not need any treatment, or you may be open to having therapies which don’t involve surgery or radiation.

Perineural invasion is no big deal and does not mean that there is a chance of reoccurrence due to it.

My score is the same as your husband’s. I opted to have aquablation 4 weeks ago . Now I have an overactive bladder which keeps me from going back to work.

Your husband might want to use his biopsy material for a Decipher test which will give you all a feel for its aggressiveness. The results are used by doctors to decide treatment. As @jeffmarc said, getting another opinion is important, and you can do a telehealth with a center of excellence.

I too had a 3+4 with an 11.2 psa and chose specifically, a radiation machine with a built in MRI, vs fused images with other radiation machines. What the doctors can see, they can treat. I also felt the treatment parameters with that type of machine exposed less healthy tissue and therefore less side effects. So far so good. I was treated in February of 2023 and had spaceoar inserted.

In October 2023, I was diagnosed with Gleason 3+4, after having a prebiopsy PSA of 7.8 and a mpMRI revealed PIRADS 3, 4 and 5 lesions (see my profile for full details).

I agree with all the previous comments regarding getting a Decipher score.

IMHO, with a Gleason 3+4 diagnosis, knowing your Decipher score is essential, especially if you want to consider active surveillance (AS).

My Decipher score was 0.22 (low risk) and the accompanying Decipher GRID report (and my urologist) recommended active surveillance.

You will have to ask specifically for your Decipher GRID report…. I called Veracyte to obtain mine….an example of a part of my GRID report is attached, including the AS recommendation based on a “clinical-genomic” model of my particular situation.

If my Decipher score had come back “high risk” (>0.60) I would have most likely moved in some sort of conventional treatment direction.

I may still have to move in that direction someday, but 21 months after diagnosis my situation is demonstrably stabilized, based on follow up PSA levels and a follow up mpMRI. Monitoring is key to good AS practice.

Another word of encouragement, with a Gleason 3+4 diagnosis you have time to do your own research to become completely confident and a layperson “expert” regarding your particular diagnosis and treatment options.

In other words, don’t let anyone push you into a decision for which you are not fully comfortable.

It’s you and your husband’s life and quality of life that hang in the balance and the good news is that you have as much time as you need to make an informed decision, after being diagnosed with Gleason 3+4.

Ha he had an MRI? Was the biopsy targeted or was it a random TRUS biopsy?

Thank you so much for your detailed information and kind words. What really concerns me is at the bottom of the results. This is what was written:

Note: Perineural invasion and intraductal carcinoma are identified in this case.

Perineural invasion is not uncommon and does not preclude successful surgery, nor does it necessarily indicate local spread. Surgery might be a bit more extensive, but still very good outcomes.

my Gleason score was 3+4 in on biopsy sample and 3+3 in another; no cribriform and the other 10 biopsy samples were OK. Decipher score: ..45, I'm 79. For me, Active Surveillance seems right. All the previous responses are on the money. Get the Dr Walsh book--it's a great resource. Take time to get more and more information (other opinions, too). Based on the results you describe, there's no rush.

Your husband unfortunately has IDC( intraductal carcinoma ) which is very aggressive feature according to papers and doctors. If you are not in a center of excellence you should find one and go there for second opinion on biopsy findings and proper treatment. Although perineural invasion is not of extreme concern it IS a concern and as you said yourself shows cancer trying to escape the gland. Ask for Decipher BUT be very proactive (as you are already), I would not personally wait for treatment. My husband unfortunately has IDC and cribriform gland formation and I understand your concern and worry < 3.