New prostate cancer diagnosis: Facing treatment decisions

It looks like the worst problem is here

M - MRI #1 Left Peripheral Apex - Prostatic Adenocarcoma 3+4=7
4 0f 4

They took four cores and all four were 3+4

Then it shows this

Pattern 4 10% 4 of 4 6.0mm, 5.5mm, and 4.0mm
60%, 60%, 30%

And it’s confusing about whether or not they’re saying that the pattern four is 10% in one core 60% and another 60% in the third and 30% in the fourth.

If that’s truly the amount of four and those cores that’s quite a bit and would call for treatment.

Ask the doctor about what it really means, If it’s what I suggest Then active surveillance would not be the best idea.

@jeffmarc
M. Prostate, MRI #1 left peripheral apex; core needle biopsy:
- Prostatic adenocarcinoma, Gleason score 3+4=7 (Grade group 2).
- Gleason pattern 4 comprises 10% of tumor volume.
- Tumor involves 4 of 4 tissue cores.
- The linear amount of tissue with carcinoma is 6.0 mm, 5.5 mm and 4.0 mm.
- Tumor volume is 60%, 60% and 30% of the involved cores.
- Perineural invasion is present.

From what I gather , 4 score, is 10%,of total 4 cells in the 3+4.
The other percentages,are the percentage of cancer present in each core.

I had a low risk Decipher score, as you did, and my prostate cancer was confined to my prostate as well. I chose a radiation machine that had a built in MRI (in my case the Mridian, and the Electra Unity is the only other one on the market) because it limited the exposure of healthy tissue, and therefore side effects and quality of life. I could have gotten focal therapy but I felt because it treats only part of the gland, there's a chance some cancer cells are missed. I was trying to minimize biological re-occurrence. So far so good. I was treated in February 2023 by an oncologist trained at MD Andersen.

If you are looking at focal, I would take a look at Tulsa Pro. It has more precision than HIFU as it uses MRI to insure margins and temperatures are accurate. Click on my profile and you can see my experience.

@ferguto1
That is a lot of tumor in those four cores. It is not a lot of four, but there’s a lot of three in those cores.

I guess this is something you really needed to discuss with your doctor. Do they feel that the low amount of four would enable you to go on active surveillance safely?

Yes, Perineural invasion is present, but it is found in so many biopsies. It was found in mine and I’m still here almost 16 years later. They do say it adds aggressiveness. Maybe that’s a reason not to consider active surveillance. This looks like a case SBRT radiation could be successful in eliminating the problem.

@jeffmarc
Doctor pretty much gave me any option at this point. Been trying to do my due diligence, and narrow down choices. The area with a higher percentage of cancer and a few 4 cells , was my biggest concern. If not for that , I’d lean towards AS.
PSA and Decipher scores are at least encouraging.

@ferguto1
Have you tried going to a center of excellence to get a second opinion? At this point it sure seems like that is what you will need to make a decision.

Here is a good website to compare odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see the odds of 10-20 yr survival, etc. based on the treatment you pick.
https://www.prostatecancerfree.org/compare-prostate-cancer-treatments/
It is best viewed on computer or just print it on paper. Not so viewable on phone.

To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.

Also be aware the the graphs don’t show any salvage radiation benefit. This would boost the surgery odds up a bit.

And, this is a very dysfunctional industry from my view. Loads of bad info mixed in with the good info. Same with the docs. Many of them are more dangerous than the cancer.

You were given three choices by your doctor. Trust your doctor and talk about the risks and benefits. Your decipher is fairly low and while you have high cancer in some of your samples, the rest are not of concern. With your age, decipher and everything else, I would think AS would be a good path for a bit because while you had a jump in your PSA, it dropped on the next PSA. In other words, you have a confusing set of results and nobody on this site is qualified to really tell you which direction you need to go. You are young enough that I suspect surgery would be pretty easy for you to recover from, but it comes with risks. Focal therapy is still somewhat new and long term efficacy is not as established as traditional treatments, so take that for what it's worth.

My results were similar to yours, except my decipher was twice yours, and I opted for surgery. I was also 8 years younger and in good physical shape, so those were factors.

I heavily explored the less invasive therapies and there were too many question marks for my own personal taste, but others seem to be happy with their results so far.

Talk to a handful of doctors, get multiple opinions, do not let a forum dictate the direction of your life. I had the surgery and had absolutely zero side effects. Hopefully it's gone for good and I never have to worry about it again, but cancer is cancer and I might be battling this for the rest of my life - but I took action based on 9 different doctor consults and am confident I took the right path.