What would you do?

You need to tell us what treatments you ve undergone for this in the last two years, RT, chemo, ADT.?

I had a 3+4 as well & just had it removed. Radiation didn't appeal.
But as ecurb says, it depends on what other treatments have been tried (if any).

Haven't done any treatment at all. Just active surveillance for 3 years.

I had a MRI a few weeks ago with a PI-RADS v2.1 score: 1. Which in hindsight seems useless. My biopsy was a few days ago on Monday.

I don’t think you Included all of the biopsy, It’s possible there was something more important. You have a very low chance of cancer here. You only have 5% of 4 in one core. These days, many doctors would recommend active surveillance. I have some videos from two different doctors discussing it and they would probably interest you if you want to see them just reply back.

Now for your urinary issues, Have they put you on antibiotic? If you have BPH that’s what they do to shrink the prostate and resolve some of the issues, Other people have said they had to do in these forums. Have they talked to you about doing a Turp? That might resolve your problem peeing. Maybe you’d prefer having a prostatectomy, I’m pretty sure you can still get an erection after a Turp, Which would be a big advantage.

They can scope your bladder after you pee. They just put this thing against your stomach and they have your bladder on the scope. My urologist did that with me to see if I was evacuating completely.

Well, these are just a bunch of things to think about And be aware of when you talk to your doctor and get treatment options. Your doctor has a lot more information than I do about your system.

Thanks for your reply. Yes I would like to see those videos.

Yes I have tried antibiotics for BPH and it did nothing. Ive had BPH for years before I was ever diagnosed with prostate cancer. I had a test that shows I am not fully emptying my bladder years ago. My prostate is steadily growing and interfering with urination, its 2-3 times the size it should be. I briefly discussed the TURP procedure with my doctor a week ago. What bothers me about doing that is it still leaves the confirmed cancer cells in place to multiply over time.

My thought is why not get rid of both problems at the same time, and hopefully be done with it. Instead of jacking around with it every year for years hoping it doesn't get worse.

When it comes to erections I have had a penile implant for 2-3 years now so that wont be an issue.

I also have read in some of these forums where guys with the same 3+4=7 Gleason score as I where the cancer had already metastasized outside of the gland and that wasn't observed until after removal.

Thanks again for your reply!

Really disappointing to hear how you’ve not been able to resolve this BPH issue.

Since you have the implant you avoid the worst side effect of having surgery. The surgery itself is pretty easy. I guess in your Case you have no choice, radiation would probably not resolve your issue? Have you spoken to a radiation oncologist about this, I have no idea, but I would think about doing it, maybe if they destroy everything inside your prostate except the sphincter you won’t have problems.

You are left with one sphincter when you get your prostate removed, That’s why some people have incontinence problems After surgery.

I had a Gleason 3+4 after biopsy and 4+3 after surgery. It’s very common to have it change.

At this point, I can understand why you would want to get the surgery. I’m including these videos just because you asked.

Here is a video with Dr. Laurence Klotz, one of the experts on active surveillance. He can give you answers as to why you would or would not be a good candidate for active surveillance.

So you decided on some type of surgery after getting the same biopsy score as I, 3+4=7? If you don’t mind my asking, what procedure did you have done? With what little I know about this subject I would think if you had your prostate removed your Gleason score would just go away? What would be left to biopsy?

Thanks

I had a 3+4 with a low decipher score and decided to have Radiation with a specific built-in mri machine. My prostate was smaller with no Perineural invasion. I would absolutely get another opinion from a center of excellence. Look at all your options. I was 69 when I was treated.

@someoneelse
Why would you not consider radiation versus RP? I did not have RP just radiation and very mild side affects. My PSA went from 3.75 to my last one was .10

I am not sure from your post was hormone treatments recommended? Your Gleason scores are not high which is why you were probably put on A.S. I do not see a Decipher test on your post. Did you have one? It would tell you and your doctors the risk level of your cancer.

Having suregery to remove your prostate is a major surgery with many possible side affects. Some go through it with mild and some go through it with a lot of issues. Thus be very important to research the common side affect of RP and then side affects of radiation.

In today's treatments the radiation treatments are really far advanced. If I had to decide all over again I would still go with radiation and not have major surgery.

Would this situation be a candidate for Tulsa pro/ablation since it is localized? And treat Bph independently?