Doc just recommended treatment options, head is spinning! Thoughts?

One thing you want to find out is what percentage of the 3+4 had cancer? Also, what percentage of it was a four. It’s possible if it’s very low percentages, you could go on active surveillance for another six months to a year.

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.

You might want to get a second opinion on your biopsy. There are doctors that are specialists in doing that and they can give you a lot more information about what’s going on but it will cost you $500.

Two of the best people that do this are

Dr. Epstein biopsy
https://advanceduropathology.com
Dr. Zhou

Send an email to Ming.zhou@mountsinai.org to inquire about a second opinion and ask for his specific instructions for the process.

The long-term results from surgery and radiation are about the same. If you get surgery and it comes back, you can get radiation. If you get radiation to start, then surgery is very difficult and only a few Specialists do it.

If you were to get surgery, you want to find out if your doctor could do nerve sparing, which can usually allow you to get an erection after.

If you get radiation, you will probably not have ED right away, after a couple of years, some people do lose the ability to get an erection. If you get surgery with nerve sparing, you may take a while to get your erection back, but it will usually come back.

Gleason 3+4 is the lowest result that even counts as cancer, so after you get some follow-up tests (radiology scans, germline genetic testing, etc) to confirm you're low risk, active surveillance — vs surgery or radiation — would be a very reasonable choice.

You're in emotional shock right now — that's normal, and we've all gone through it with a new prostate-cancer diagnosis — but trust that before long, you'll adjust to your new normal and your life won't be all that different than it was before, especially since they caught this so early.

Best of luck!

If you go Focal (HIFU), check into Tulsa Pro. It is much more precise than HIFU as it is done with MRI guidance. The MRI ensures precision margins and that all the tissue is heated to the proper temperature to kill the cancer. Click on my profile for my story. I was 4+3 when I was treated in July of 2024. No evidence of cancer at this point and my PSA has held steady at .70. Was 8.6 prior to Tulsa.

I had a similar experience and, at just 54, I was in treatment territory last year. Here is my experience, glean from it what you feel helps, but I think you and I are kind of peas in a pod here:

My PSA was rising but was never 4+ until last year, 3.78 as my highest until then and I ended up with over 4. This prompted all the normal things: DRE, biopsy, MRI, etc. The biopsy was similar to yours, lots of 3+3 (not considered "cancer" much anymore) and some 3+4. Due to this, I was suggested for active surveillance. At the same time my urologist sent my biopsy in for a Decipher, which came back 0.68 - which is risky and aggressive cancer. He recommended surgery.

From here I went to 8 other doctors for opinions in urology, medical oncology and radiation oncology. To a doctor they said "surgery" and their reasoning was the same: I am young enough to recover quickly and young enough to almost positively see side effects from radiation later in life (other cancers, bladder issues, bowel issues, etc). So, I had a quorum, everyone in agreement from multiple hospitals.

I asked if I had time to prepare, and I did, so I took 4 months and supercharged my already active life into hyper active. Massive core training and strength training incorporating pelvic floor exercises and therapy. I was giving myself the best chance of success under the knife and speedy recovery afterwards. I also gave up drinking and any "fun things to eat", this was my life and I was serious about this.

I had surgery January 28, 2025 and in under an hour after waking up, I had an erection - something even the urologist was shocked to find out about. After my catheter came out I didn't have a single millisecond of incontinence, also somewhat rare. I attribute this outcome to having nerve sparing surgery and working my ass off for months to prepare properly.

I investigated all of the non-traditional (i.e., not surgery or radiation) treatments, none of them satisfied me. I'm glad, in retrospect, that I had it out because it's the only time they can fully evaluate your prostate and your cancer. Having pathology done on the entire gland revealed that my cancer was far more 3 + 4 than the biopsy indicated and that I was even higher risk - my cancer stage was upgraded. If I nuked it then I'd never have known.

I spent nearly a year researching every treatment option, every long term side effect - my head also was swimming and I was relatively terrified (and I'm a combat veteran and thought I had no fears left). I could never find much good news on outcomes from real people, only the statistics that 90% of men get over any incontinence and/or ED from surgery within 18 months.

My choice was clear, my outcome optimal - I have zero regrets on the direction I took. I know this might still rear up at some point but I stick around here and other places to be the voice of success, of good news where none seems to exist. You can do this, you will get through it, and there are a LOT of us here to help answer your questions. Remember that 1 in 12 guys get this before aged 60 and 1 in 8 after - it's not an uncommon cancer and it's come a very long way from the near guaranteed death sentence it was 30 years ago.

Let me add another thing. I was super concerned with ED and incontinence and eventually came to the realization that neither would be the end-all. There are many steps you can take for ED (my doc had me on tadalafil for 30 days prior and 1 year post purely as a precaution, nearly off it now) with the last stop being an implant with a button in your scrotum to turn things on and off. But, if you have no ED now and get nerve sparing surgery then you have a very high likelihood of zero long term ED issues. For incontinence you can get slings and artificial sphincters installed to help. These are not fun things to experience and I decided that I could live without an erection if I had to but I would not live in a diaper my entire life and had plans regarding that if it were to be my long term prognosis (and no, not suicide).

I'm the success story, for better or worse, and feel free to DM me if you want to chat more.

@jeffmarc
"Also, what percentage of it was a four. It’s possible if it’s very low percentages, you could go on active surveillance for another six months to a year."
----
Thanks for recommending this, I hadn't noticed earlier that the biopsy report copy I was given says "A1...F1 benign prostatic tissue" and then "G1 Left Apex - small focus of adenocarcinoma Gleason score 3+4=7 involving 10% of the specimen (1 of 1 cores contain cancer) Gleason pattern 4." I'm assuming "left apex" involves 2 tissues samples, one was 3+3 and the other was 3+4, putting me in Grade Group 2.

Thanks for the suggestions on 2nd opinions, and for the "surgery > radiation" route.
I will take all of this under consideration, much thanks!

@northoftheborder
Thank you! Yes...the initial cancer diagnosis was over 1 year ago when he gave me the first "2 specimens are both 3+3" diagnosis, and after a little initial shock I adjusted pretty well, because it was barely there.
Now a year later and it's gotten a little worse, and he's recommending options that could have long-term side effects....that's a bummer. Working through that one. 🙂

@survivor5280
I greatly appreciate the story of your experience. I think it's the ED/incontinence stuff that bothers me about surgery, but I am fairly fit and tend to recuperate quickly from most everything, so with some gym rat behaviors perhaps I could come through it too 🙂

And yes, ALL of it beats an earlier-than-anticipated death from ignoring it. My wife's Dad died from that, many years ago - they didn't catch it in time and by the time they did it was in his bones.

My Dad had it 15 years ago and his PSA was already at a 17 by the time they caught it, he went through immediate radiation at that point and has horror stories of the aftermath 😉 He's surprised that with a 4.8 and a 3+3/3+4 that they're already recommending treatment, but best to move early!

@jcf58
Thanks for the recommendation! I'll mention this to my urologist, since he's certified in HIFU. The next step overall is to do an MRI and see what things really look like in there, so more info to come.

@jmgpdx68 @jcf58 gave you excellent advice but your surgeon is not gonna recommend TulsaPro over HIS hifu treatment.
But you may have greater success with TulsaPro insurance coverage wise since they specialize in this treatment.
Many times, insurance companies look more favorably on hospitals, docs and clinics that concentrate on one type of treatment.
It’s very easy these days to go on a website and check the FAQ’s…or email them directly about your coverage snd see if they accept it. Even a co-pay is totally worth it if you have such a small area of G4; surgery and radiation treat the whole gland and that’s where the majority of SE’s come from - the totality of treatment. Good Luck,
Phil