Time to decide what treatment is best

@ireland1964 no they both were pretty neutral but the urologist mentioned about more treatment options with ralp.

Thanks that's encouraging news.

@ginger38314 No mention about nerve sparing or Retzius?

The Urology surgeon specializes in nerve sparing surgery Dr. Amling head of Urology at ohsu.

A high decipher can be caused by other problems

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.

If you have one of those aggressive issues, they can cause the high decipher and can cause reoccurrence.

A 3+4 grows very slowly, normally. The decipher score can make it come back, however. You can have surgery and that way you can have radiation if it comes back. If you have radiation that could take care of it, A 3+4 doesn’t necessarily need ADT. The only reason one would consider it is because of the high decipher.

I had a 3+4 after biopsy but after surgery, I had a 4+3. You never know what your real Gleason score is if you have radiation. A number of people find out they were 4+ fives after surgery, Which could explain the high decipher.

No cabriform or any other aggressive features low volume 3+4, .8cm lesion
had a pet scan and that showed no spread just high decipher score. The
oncologist recommended adt but didn't require it. I will take a week than
decide thanks.

The urologist also mentioned men with initial favorable features and low volume of cancer but high decipher score the majority of those don't have adverse pathology after prostate removal.

@ginger38314 Hope he gave you % and margins based on images which is a big part of that decision (imo).
My first consult just said “he’ll do his best”
Retzius may be worth considering too if they feel a posterior approach works for your situation

I had ExoDx 72 and Decipher 60, Gleason 8 (4+4) , PET clear, however when surgeon got in and had margin’s checked during surgery they were positive, and fortunately he was able to go back in and obtain final negative margin.

Hopefully have the same positive outcome. My exodos was around the same as
yours but the decipher score was higher, also no spread on pet scan or mri.
Except had 2 cores 3+4 @10% 4 my decipher numbers they gave me were 5 year
metastasis 2.7%, 10 metastasis 6.5%, 15 year mortality 12.2% and adverse
pathology 40%.