Connect
Newly diagnosed T1c Gleason 3+4 awaiting Decipher results.
Am finding this group full of great information. Trying to learn as much about my diagnosis as possible. PSA 5.9, mri Pirads 4 small lesion on one side, nothing outside of prostate, biopsy 17 cores, 1 3+3, 4 3+4, 67ml prostate size, favorable intermediate description. Awaiting Decipher results. If below .5 suggesting Active Surveillance, if above suggesting ADT then continue Active Surveillance. Age 75, family history of PC, have controlled AFIB with Eliquis and been on hypertension meds for years, otherwise active and in good shape (6’1, 160). Live in Philadelphia suburbs. Are there other questions I should be asking? Should I be looking into focal therapies as an alternative treatment, my Dr isn’t impressed with recent focal therapy data regarding fewer side effects than radiation or surgery. Thanks in advance for any thoughts!
Like
Helpful
HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
Connect
What percentage of the 3+4 Was a four? What percentage of it was a tumor. Were you a T1 or T2b?
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.
I have an afib problem also, On Pradaxa. If they prescribe a second drug for you, do not take Zytiga, It is really hard on the heart caused me 4 afib events.
You are not far from New York City and it might make sense to go there to get treatment. There are even groups that give free lodging for cancer patients. Find out what your decipher score is that can help make a decision.
My brother had a couple of 4+3’s And at 77 had five sessions of SBRT radiation. He’s now 80 and doing fine. With a mild case you have that can be a good solution.
There are a few people in this form that have had TulsaPro And are very satisfied with it. You can go to the top level of the prostate cancer forum and search for Tulsa pro and you can find out a lot of information.
Not sure ADT will do much without radiation unless you use it long term (rest of life w/ some vacations). For focal therapy how many separate 3+4 lesions (did 3 of the 4 cores come out of the PIRADS 4 lesion?). If 4 all over the prostate may not be a good candidate for focal. See the Tulsa Pro & Tulsa Pro Insurance discussions. Higher recurrence rates but may be as good as short-term ADT alone with less side effects.
@pshea1
I had 3+4 Gleason and a psa of 10.2 plus a low Decipher risk. If I was 75, instead of 69 when I was treated in 2023, I would make the same choice; No Active surveillance, no ADT and I was treated with a SBRT MRI guided radiation machine, 5 sessions, in my case the Mridian, but the Elekta Unity is another machine. My prostate was under 60 ml. I did not want to wait to be treated as no doctor will be able to predict how your body will react in terms of growth of a tumor. They are educated guesses and are important but for me, anything can happen in a 3 month period of PSA testing. I was aware of the active surveillance discussions and predictions. Doctors are dedicated but they make mistakes and I felt treatment was less of a risk as once you wait anything can happen.
In New York City, Cornell Weill uses the Mridian and Memorial Sloan Kettering uses the Elekta Unity. Second opinions via telehealth can be very helpful for comparison purposes.
@jeffmarc thx for your thoughts and afib advice. In answer to your questions I was T1c. From biopsy report everything contained in prostate.
Right anterior medial, Gleason 3+3=6 grade group 1, 1 of 1 core involved. Tumor measures .97cm in length, 60% tissue area involved by tumor.
Right mid peripheral zone anterior, Gleason 3+4=7 grade group 2, 10% Gleason pattern 4, 4 of 4 cores involved, tumor measures 2.37cm in length, 35% tissue area involved by tumor.
@jim18 thx for your thoughts. Here is biopsy report on Pirads 4 lesion. Right mid peripheral zone anterior. Gleason 3+4=7 (grade group 2); 10% Gleason pattern 4; 4 of 4. Cores involved, tumor measures 2.37cm in length, 35% tissue area involved by tumor.
Hope this answers your question.