Prostate Cancer (47 yrs old) - Guidance Request

Posted by jtmarti1 @jtmarti1, Mar 30 9:09am

Hello - I'm new to this forum but recently diagnosed with 3+4 Gleason and wanted to get guidance on next steps. My Urologist is pushing treatment options (HIFU, TULSA), but I'm currently opting for Active Surveillance, but unsure if that is the right path.

My situation is I had a PSA of 2.7, MRI showed an 11mm lesion, Biopsy showed 3+4 (3+3 in other samples around cancer area), Polaris Score was 2.8 (slower moving, 1.8% risk of death in 10 years).

Given I'm only 47, I'm questioning my decision to go on AS vs. treatment. Planning to get a 2nd opinion from Mayo next month, but was hoping to get additional guidance from this forum. Thank you in advance for your input.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

There are a lot of good responses to your question. I would add this: my biopsy showed two cores of cancer, including one at 3+4. I decided on removal after meeting with two different surgeons. After surgery, my pathology report showed my cancerous core was not 3+4, but 4+5 and close to the capsule. Knowing it was a higher risk, I was glad for removal. I had ZERO incontinence issues. So far my two recent PSA blood tests showed < 0.01. Hope and pray for more of the same. My advice to you is to do everything possible to make sure your cancer diagnosis is accurate. Just realize that everyday that goes by the cancer could be growing. Best wishes with your decision.


Get the Dr Walsh book, read the “highlights” at start of each chapter then read the entire chapter to learn more when it is pertinent.

Get a PSMA scan to see if the PC is confined to the prostate or has spread.

IF, IF you choose RALP, do several weeks of Pelvic Floor PT with a DPT trained in this; and a few more weeks after the surgery. (I, at age 72, opted for RALP, did this PT regimen and was 100% continent. )

Sorry you joined out “club” but there is lots of advice available here.

Best o luck!

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Great suggestion on the PSMA scan!


First of all, good luck on your journey with this. Before I weigh in, may I ask what kind of biopsy did you have? I am hoping that you did not have a 12 core random biopsy. If you look up the published statistics for this, it can miss significant cancer over 30% of the time resulting in under diagnosis of serious disease. I am on my second bout of prostate cancer. My first biopsy in 2020 missed significant disease and it showed that I had a 3+3 Gleason score. I wanted a MRI fusion biopsy so that they could actually accurately sample the lesion. My insurance wouldn’t pay for it so I got the best biopsy I could under the circumstances which was a grid type transparineal biopsy. I chose the least invasive treatment to preserve erectile dysfunction which I thought was successful until March 2023 believing that that would be enough. I now have stage three metastatic prostate cancer, have had salvage prostatectomy and now I have to go through seven weeks of salvage radiation and then two years of ADT all because I was under diagnosed with a poor biopsy. You are a young man with a full life ahead of you and I suggest that you continue to educate yourself, be well informed from credible sources, seek the best medical help you can find and your own advocate. Good luck on your journey.


Some important matters about PC are: 1. It kills more than 40,000 men each year 2. It grows but usually slowly 3. If your PSA is increasing you need to have a biopsy ( it does not hurt and you’re back home the same day ) 4. If the biopsy is 6 or less then regular observation is proper but more than that requires PC treatment. 5. Treatment by Robo surgery or radiation is about equally effective but if you have radiation then usually you cannot have surgery later, if and when your cancer returns. For that reason and considering your young age, I would seriously consider aggressive treatment of surgery as it preserves more treatment options.
6. Examination of the prostate after surgery gives a more complete diagnosis. My biopsy indicted Gleason 8 but after surgery they upped the diagnosis to G 9 and that effected the type of treatment that I needed. 9. Get tested and treatment at an excellent facility even if you need to travel there for treatment as cancer is life threatening and not just an inconvenience 10. Most of us are not physicians and you need the advise experienced urologist and their medical team
Best of Luck to you, we have all been at the crossroads that you at presently in.


ADDING to my previous post:

My PSMA scan showed my cancer was confined to the prostate - no spreading.

I chose surgery because the cancer had not spread, and that surgery after radiation is not a good option.

From the pathology report, it had been determined Thad my prostate had another type of cancer, one that WOULD have survived radiation.

I wish you all the best!


Hello, glad to hear things are going well for you. I too have Prostate Cancer 3+4 Gleason , two areas as well as 3+3 in three areas of prostate. I have been to mayo Rochester. Initial trip to see about radiation. Have a follow up with surgeon. trying to decide on treatment. Also have a quite large prostate gland at over 100 cc. Possibly leaning towards surgery. Would you mind disclosing who your surgeon at Mayo Rochester was? Trying to put together all the info I can beforehand. Thanks! Tim

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SCJ428, so sorry for the delayed response, was out of town for a few weeks and did not have access to Mayo Connect (didn't bring password).

My surgeon at Mayo-Rochester was Dr. Igor Frank. He and his team were amazing, always willing to answer all my questions in depth and never in a hurry to get out of the room. I have referenced him to several friends and Mayo Connect patients and all have been very happy.

Best of luck and please let me know if there is anything else I can provide.


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