Received the news on Halloween. I have prostate cancer. Need advice.

Depends on where the tumor(s) are located. If near the colon wall I would not just sit there and watch as that is a danger zone. Once in the colon, things become more difficult. If central, then maybe a wait and watch, but I can assure you that your gleason scores will change. I would undergo a a URONAV biopsy for precise location.
My second biopsy cancer cells were missed entirely until the a guided URONAV was performed.

I'm a fit 74 year old. I had the same (3+4) Gleason score as you on my second biopsy, a year after the first 3+3. I ultimately decided to have radiation treatment, but the reasoning is possibly useful to you. Yes, I could have continued Active Surveillance, but we already see that the cancer is growing, even if it's not high risk. The doc said he could not endlessly do biopsies. I had a Decipher test (highly recommended) that showed relatively low risk and no need for hormone therapy, but still...how long do you want this growing within you? That's a question every man needs to answer for himself. What I found is all the tests and medical appointments were very stressful and it was affecting my mental health and my partner's. I decided let's treat this now rather than later and try to move on with life.

Someone recommended this boat to me, and I found a very helpful: Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer.

Lots of great advice. Let me add two more thoughts for you.

One if you don't have it get Dr. John Walsh's book on "How to Survive Prostate Cancer", get the 5th edition. You will learn everything you need to know.

Two, consider a plant based diet, away from dairy and animal fats. Not conclusive but seems to reduce the spread of prostate cancer.

Best wishes on your journey.

The optimal radiation dose is provided by Interstitial Radiotherapy (a/k/a permanent 'seeds', low dose brachytherapy, LDR brachytherapy. Go to PCRI.org YOU-TUBE video entitled Brachytherapy 101, listen to the Q & A afterwards for other clinicians qualified to preform it, Also see results of the 2025 of the Annual ASCO Meeting on that same website. There is a problem with recommending 'LDR' its reimbursement return is too low.

My results were similar and I was going to be on active surveillance until my Decipher score was high enough to cause concern. But, even with that, I had plenty of time to get my ducks in a row before doing anything and I talked to 9 different doctors (urologists, medical oncologists, radiation oncologists) to make sure everyone was on the same page, and they were, so out it came. So far, so good, no side effects and doing well.

Now that you have been given more time, make use of it and find out everything to know about PC and talk to every doctor you can - especially while in the final throws of this deductible year!

@frank1956 I am sure that was spooky Halloween news for you. I am a UCLA patient as well (soon to be 74 yo) with similar Gleason scores (3+3 and low volume 3+4) on initial biopsy 10/2021. Low Oncotype scores and negative for BRCA mutations, I was recommended AS. After 4 years my PSA escalated and biopsy showed transition to Gleason 4+5 with unchanged MRI and PSMA PET Scan localized disease. AS allowed me 4 years without intervention, though with the changes this summer treatment clearly was necessary. I just completed high dose SBRT regiment at UCLA Radiation Oncology and started ADT (planned for 12-18 mos per RO). Good luck to you on your journey.

@frank1956 A few years ago, I was in a webinar with Dr. Jonathan Epstein (Johns Hopkins) as the speaker. He made a comment regarding 2nd opinions that was something like “If two pathologists agree 2/3rds of the time, that’s considered good.”

(Prior to starting my proton radiation treatments, a 2nd opinion upgraded my Gleason from 7(3+4) to 7(4+3). Not knowing which was “right” - the 3+4 or the 4+3 (since they were both educated, experienced opinions) - I chose to be treated per the higher Gleason. So we simply added 6 months (two 3-month injections) of Eligard to my treatment regimen.)

That’s good that none of those terms are mentioned in the MRI or biopsy reports. Some of those terms are indicators of more advanced disease.

Regarding Free PSA. That’s not a standard PSA test, but they’ll do it if you ask. PSA circulates in the blood in two forms – either attached to certain blood proteins or unattached (“free”). If the PSA is between 4.0-10.0, but the % of Free PSA is low (< 25%), it may indicate a higher disease risk. (Another datapoint in the decision-making process.)

PSA Doubling Time (PSADT) –> The number of months it takes for PSA to double. If the PSADT was < 10 months, patients tend to do worse. (Again, just another datapoint in the decision-making process.)

I think you are following the standard protocol fo this type of event. Your doctor seems very thorough and conscientious so a deepening of trust might be in order. In addition, I might suggest that you stay aware of your level of fear. From my perspective it can lead to suffering. Best of all things to you on this journey…

@jcf58
Yes. The doctor who did my biopsy twice is part of their Tulsa Pro team. Next week, when I meet with him, I will certainly ask for the qualifications of being a candidate for that procedure. The challenge that I see is, I have 3 cores with cancer, and they are in 3 different locations. Partial ablation might not be possible. I may need total ablation if I chose Tulsa Pro.