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Very sorry to hear of your husband’s diagnosis. At his age post 75, very few Surgeons consider surgery, typically Radiation. Focal therapies also kick the can down the road with typically recurrences. This forum will provide alot of information to assist your discussions with your husband’s Urologist. Jeff Marchi and Clevelandguy on this board are able to provide exceptional guidance.

What was the PSA? Did he have a MRI? Where there any other cancerous cores found? What percentage of type 4 was in the core? How large was the lesion (from MRI)? Were all cancerous cores on one side of prostate? All of those will be taken into account to determine if focal therapy will work. Due to high recurrence rates, it will probably not be recommended. Likely to recommend radiation with higher type 4 percent or lots of positive cores. Could be active surveillance due to age and diabetes if low type 4 and few positive. Besides the current stage of the cancer this decision also takes into account how long your husband is likely to live given his current health and genetics (how long do his male relatives live)?

@jim18 gave you excellent points.
I would just add suggestion that Decipher test should be done (to check aggressiveness level of the cancer and it is done on the biopsy samples).
Also - do you see any cribriform glands or IDC in pathology report ?

He needs to have PSMA scan also - to check if cancer is truly localized.

Due to his age and comorbidities he would most probably benefit more from RT than surgery. It is best to have separate discussions with surgeon, radiation oncologist and focal treatment specialist and than make a decision.

As a wife, I understand your anxiety and worry and am sending you a big hug 💗.

My brother was a 4+3 and at 77 had five sessions of SBRT radiation along with six months of Lupron. He did have some problems with peeing, but it was a resolved with Flomax every other day, That problem only lasted a few months. He’s 80 now and doing fine. Because you are a 3+4 they may not want to do ADT. He had small cribriform And PNI.

I had Surgery at 62, I also had PNI. It seems that I see PNI Quite frequently, it is not really considered a real aggressive problem. After surgery, I was a 4+3. I’m still here 16 years later, even though I’ve had four reoccurrences and have BRCA2 a genetic problem that makes my cancer much more aggressive.

Prostate cancer is a chronic disease for most people not a deadly disease.

I'm sorry to hear it. News like that is always a shock.

The good news: that's the lowest Gleason score that even qualifies as cancer. There's an excellent chance that he'll need to treat it only once.

The concern: they typically follow up treatment like radiation or focal therapy with androgen-deprivation therapy (ADT) for a few months. Unfortunately, ADT exacerbates insulin resistance and it could affect your husband's pre-existing diabetes, so definitely bring his endocrinologist into the conversation early, and (if they both agree) even set up a meeting between his oncologist and endocrinologist to coordinate his treatment.

@wheel1
Thank you.

@jim18
The MRI showed 2.3mm PSA was 12.8, his dad died of an aortic aneurysm at 64 but his mom died at 93 of Alzheimer’s. Other males no sure…

@surftohealth88
Thank you so much hugs are so appreciated…

@jeffmarc thank you for the information.

@northoftheborder thank you that is something I didn’t think about bringing both together…