Biopsy results

At gleason 3+4, 60% involved probably looking at treatment. Ask about AS but, i was encouraged to stop with 3+3 because 2 my cores were over 50% and my relatively young age. Meantime get up to speed on treatment options. PCa is not typically fast moving so, don't panic do your research and find best facilities. Also, want to find out if there are indications of metastasis as that affects treatment.

Yes, those are wise words.

Time for serious research. Fortunately you have some time to do that and choose what is best for you.

Can’t speak for Radiation but if you decide to go the surgery route, just be aware that their are different techniques of Robotic Laparoscopic Radical Prostatectomy surgery that can help with incontinence issues and ED issues.

As Old Salt points out it definitely always needs repeating the number of surgeries is of utmost importance. Most times Urologist’s are absolutely fine for the biopsies, but when it comes to surgery they may tout their experience, but just by numbers and the need to be up to date on latest technology and techniques they fall short. Actual Surgeons specialized in prostate surgery are likely the best bet. My urologist actually explained this to me and why he stopped doing the surgery. He said a surgeon getting referrals from a number of urologists will stay constantly busy performing surgery while an individual urologist will do far less. I will read about patients getting surgery from their urologist obviously due to them knowing their urologist. I would recommend that they don’t limit themselves to automatically agreeing to have their urologist perform the surgery.

regardless of your treatment approach, look at the the members of just this group with many years of treatments , remissions, recurrence’s, treatments again, and they are here 15 years later. What is important is that life expectancy is very high regardless of numerous treatments when cancer is caught and treated early and was not allowed to metastasize to the bone. You will be here for your daughters and a grandfather one day!

I see quite a few similarities with my situation. Gleason 3 + 3 should just about always be AS but Gleason 3 + 4 really is that gray zone where all the options mentioned are brought into play. Radiation was out for me due to other problems. I was thinking to continue AS but the Decipher test changed that. I'm glad that you'll be getting one. It can really be the tie-breaker in 3 + 4 patients. My results showed I was at high risk genetically. That brought an end to continued safe AS and surgery was scheduled ASAP. I had the surgery on 10/21/24 and the pathology showed somewhat more advanced cancer than the initial biopsy indicated though I was still Gleason 3 + 4.

Hopefully you will be low risk and can take your time weighing your choices.

Focal treatment is certainly an option, but you do realize that further treatment down the line is often necessary?

Not really. The thinking is that in addition to the (four) cancerous site that have been identified there may well be other sites where cancer is 'brewing' but that do not show up right now because they are too small to 'see' or have been missed by the biopsy. In due time, these cancers MAY grow and need treatment.

The choice, therefore, is to treat the whole prostate now or just do the focal and follow up with regular PSA tests to see if anything else develops over time. Not a straightforward decision.

I try to be 'data driven' and I don't have all the data. As many have stated in this thread, you have options and, significantly, some time to decide which one is best for you. The decision process should include the expertise of the specialist. For instance, it wouldn't be wise for me to recommend therapy X if no X specialist is available to you. Insurance may play a role as well. Your overall physical condition is relevant, as is your Decipher score.

As an aside, you could ask for a scan to more definitively rule out metastasis although your urologist may not go along with that because your Gleason scores are relatively low.

I repeat what your urologist wrote:

In summary, the patient presents with a new diagnosis of prostate cancer here for high complexity decision making regarding management options.