Newly diagnosed stage 2. Trying to decide on a treatment plan.

Putting your biopsy in this forum would give us a lot more information about what your situation is. Just knowing you are a great group 2, is not enough. How many cores were taken and how many of them had at least a 3+3 or higher?.

Were any of these things found in the biopsy intraductal, ductal, large cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

Because you got prostate cancer so young, you should get a hereditary genetic test. If there is cancer in your family, it’s even more important. Breast cancer, Prostate cancer, Pancreatic cancer and other cancer can be due to genetics. I got prostate cancer at 62 because I have a genetic problem. My brother got it at 77 because he doesn’t, But we both have a father that died from prostate cancer, Another serious problem, resulting in more than doubling the chance that we could get it.

Sorry, new to this still getting my bearings. My gleason was 3 + 4 and my Decipher Genomic score was 0.18. PSA 2.4, clinical stage T2a. I believe the Dr did 20 core samples total. I've had a PET and no other cancer was found elsewhere. I don't know the answers to your other questions, but I'll inquire.

MRI results:
1. Vague area of mild diffusion abnormality in the LEFT peripheral zone at the mid gland towards the apex without suspicious enhancement, indeterminate.
2. Prostate gland volume of 20 cc.
3. No pelvic lymphadenopathy or suspicious osseous lesions.

Total PI-RADS score: 3 - Intermediate (the presence of clinically significant cancer is equivocal)

Narrative

3/21/2026 7:21 AM

HISTORY/REASON FOR EXAM: Prostate cancer

TECHNIQUE/EXAM DESCRIPTION:
MRI of the prostate without and with contrast.

The study was performed on a Philips 3.0 Tesla MRI scanner.

Sagittal and axial T2; oblique high resolution axial and coronal T2; oblique axial diffusion-weighted imaging and ADC map with B values of 100, 400, and 1000; oblique axial dynamic postcontrast images of the prostate; postcontrast T1 fat-sat sequence of
the pelvis.

1 mg of glucagon was administered intravenously prior to the exam.

20 mL ProHance contrast was administered intravenously.

COMPARISON: 8/10/2023

FINDINGS:
The prostate measures 3.4 x 2.7 x 4.2 cm with a volume of 20 cc. Prostate density is 0.11.

Peripheral zone: Tiny T1 hyperintense focus in the RIGHT peripheral zone toward the apex. Several ill-defined areas of mild to moderate T2 hypointensity, consistent with sequela of prostatitis.

Transitional zone: Stromal and glandular nodules.

Prostate lesions:
Lesion #1:
Location: Left peripheral midgland (PZpl)
Size: 0.6 cm
Capsular involvement: Lesion abuts the capsule. No seminal vesicle invasion.
DWI/ADC score: 3
Enhancement: "-"
Total PI-RADS score: 3

The bladder is normal in appearance.

No adenopathy is identified.

No suspicious bony lesions are identified.

@172sar
If the doctor did a 20 core sample, then you should have a biopsy that shows each core and the result.

You say 3+4, but you don’t say how many were found. The information you supplied is not enough to really know what happened in the biopsy.

You include a 2023 biopsy that apparently found nothing.

Can you locate the biopsy report with all 20 cores listed in 2026?

If you have a single 3+4 you might even go into active surveillance if it has a low percentage of four. Another thing that would be useful to find out from the biopsy.

Your report sounds a lot like mine, and I was diagnosed In January. Im 57yrs old, and im having my prostate removed in 13 days. When all this started, and when I still didnt know if it was cancer or not, I already had it in my mind i was going to do radiation treatments if positive, but after hearing if the cancer comes back years later, then surgery is mostly out of the question. Im still young, and since my cancer is isolated to just the prostate, i chose to to just get it out of my body as fast as i can. I also had the choice to go on active surveillance, but i didnt want it to have a chance to grow and spread, even at a slow pace. You have come to the right place, for these people on this forum have really set my mind at ease, and helped making my decision easier for me. good luck my friend.

As mentioned, we need how many cores were positive and other things.

You don't mention if you want to maintain your sexuality as a preference. For me, I had to learn, tell each doctor you are married and your sexuality is important. If you don't tell them, they don't know, and they will over-treat at your expense. Be sure you understand and state this, it is important as urologist especially often assume once you hit 50 your sexuality is of no interest, which isn't how it works.

Your decipher is incredibly low = no genetic risk. I will say however, decipher has a handful of genes it tests, like 22 only. There could be 100 or 1000 genes involved so I consider decipher, which a number of doctors trust for some reason, to be just about bunk as far as science goes. You test 22 of 1000's possible genes involved in PCa, and proclaim a risk level, that is bunk science. So in my opinion decipher is not the best.

You have not only no BPH (enlargement) but one of the smallest possible prostate sizes one could have just about, so that makes any care you get easier.

Your doctor doesn't mention so many other treatments. There are many other possibilities. Usually doctors only mention what is in their system, or what they studied. There are more options than mentioned to you.

@mpersonne
Thanks, I'm leaning in the same direction for the same reasons you listed.

@bjroc
I'm trying to learn as much as I can before I go back in in a couple weeks to make a decision. It's pretty overwhelming. I'll remember the sexuality angle, it's still pretty important in my life.

@jeffmarc
I've requested the biopsy results, thanks for the feedback.

@172sar
FAVORABLE INTERMEDIATE RISK PROSTATE CANCER COUNSELING: Reviewed NCCN guidelines
showing patient falls into favorable intermediate risk category based on Gleason 3+4 w/ only 5% pattern 4 and
less than 50% cores positive. Emphasized very low risk of cancer-specific mortality (less than 5% at 15 years
w/ treatment). Explained that only 1% risk of lymph node involvement, so bone scan and extensive staging not
currently indicated. Discussed Decipher genomic testing which analyzes genetic expression in cancer cells to
refine risk stratification and confirm appropriateness of active surveillance if chosen.

One line summary: 52M w/ favorable intermediate risk prostate CaP (Gleason 3+4 w/ minimal pattern

@172sar The other option is AS with focal ablation of the lesion. This can be done with laser, DC current (NanoKnife), Ultrasound (TulsaPro), or Cyro. All of these treatments have higher reoccurrence rates than radiation/RP but much lower side effects and do not preclude any later treatments.
It might also be useful to get a second opinion on your biopsy. If pattern 4 was under 5% it would have be classified as 3+3 with a note that some pattern 4 was detected. Does an expert 2nd opinion show the cancer to be less or more severe. That may determine if you go AS or AS with focal.
Regardless of what you have been told ALL of the PCa treatments that will really suppress the cancer have significant risks of ED and incontinence so you should not rush into either RP or radiation. Also, none are a final cure as some on this board have had reoccurrence 15+ years after RP when you would be 67.