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I Was Diagnosed With PCa Gleason 4+3=7

Sw1218's picture
Posts: 55
Joined: Jan 2016

hello, good people. i'm a 45 yr. old black male who was diagnosed with PCa gleason 4+3=7. i had an mri that found 3 lesions on my prostate. i'm depressed, scared and don't know how to take all of this in. i'm not sure if i caught it early, or if whatever treatment i choose will be right for ME here is some pathology information and below is the letter that was emailed to me from the staff.  the 1st. lesion was benign, 


the 2nd lesion right mid-gland was gleason 4+3=7 {grade group 3} involving 3 of 3 cores {95% discontinuous <5%<5%} gleason grade 4 component involves 60% of the tumor. perineural invasion is present and chronic inflammation. the third lesion diffuse left mid gland gleason 3+4=7 {grade group 2} involving less than 5% of the fragmented cores. gleason grade 4 component involves 5% of the tumor.


As I discussed with you, your pathology results for your prostate biopsy indicates that SIX of your EIGHT sample cores were positive for prostate cancer.


The severity of prostate cancer is graded on a scale from 2 - 10 called the Gleason Score. Prostate cancer with Gleason Scores 7 - 10 are considered ones in which medical intervention is required. SIX of your prostate samples from the three lesions previously identified by MRI prostate had Gleason Scores of 7 or greater. Medical intervention is typically radiation therapy or radical prostatectomy (surgical removal of the entire prostate). 


Your earlier MRI indicated that there was no evidence of spread of cancer beyond the prostate to the lymph nodes or pelvic bones. 

any advice and real encouragement would be great. also can anyone tell if it was caught early or the stage of the cancer?


Posts: 35
Joined: Feb 2019


Here is an informative video that discusses your treatment options.  Before making any decision I would probably seek further tests to confirm the cancer has not, and will not, spread.  In short, if the cancer is highly unlikely to not spread then you have a very good chance of a cure.  All is certainly not lost.  If you have not already done so, I would also suggest you dramatically change your lifestyle and eating habits.


Sw1218's picture
Posts: 55
Joined: Jan 2016

what tests should have done to confirm whether or not it has or will spread? the MRI i had wrote that there were no central gland abnormalities, no extraprostatic tumor exrtensions and my seminal vesicles were normal. urinary bladder normal, pelvic lymphadenopathy normal and no enhancing pelvic bone lesions. do you think it was caught early?

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3308
Joined: May 2012


A gleason of 7 indicates "intermediate" aggressivity, neither mild nor severe. The percentages reported indicate a fair amount of "volume," or how much room within the gland the cancer is occupying.

The result of "perineural involvement" means that PCa is inside the sheathing, or nerve coverings, inside the gland. It does not mean that it is outside the gland, but it is not something to ignore.   I would meent with both a surgeon and a radiation oncologist to begin planning curative treatment.  It remains a GUESS if there is spread, but very  possibly there is not.  Meet with your doctors and discuss these issues. PCa is always very treatable, and in most cases, curable, or at least cure is a reasonable prospect.  Also, PCa advances very slowly.  The is absolutely no reason to panic because of this.


Posts: 35
Joined: Feb 2019

I had a bone and CT scan, and I am in the process of having an Oncotype DX gene test.  Dr. Scholz discusses the options at the link below, which many, including your urologist, may not agree with.


lighterwood67's picture
Posts: 209
Joined: Feb 2018

You can look at this study on PNI:  http://cebp.aacrjournals.org/content/26/5/719.  There is data to support the hypothesis that perineural invasion creates a microenvironment that promotes cancer aggressiveness.  You have some decisions to make.  Just do your homework.  Educate yourself.  No need to be afraid or depressed, but be sure and tell your doctors that.  You are still you and you need to address the issues.  The routes to attack this cancer are many, but can limit each other if you have to backtrack and there are side effects to every treatment.  I elected the RP route.  I call it AT (active termination).  You will need to make your own decision on what route you want to take based on the information provivded to you. Good luck on your journey.


Posts: 461
Joined: Jun 2015

Hi SW,

I had perineural invasion and elected robotic surgery for my choice.  I worked through the leakage and the ED which took about two years. I now have a small amount of stress leakage and the ED is gone.  To me worth the effort knowing “so far” the cancer is gone via zero psa tests for the last four years.  For me its bad enough waiting the results of every psa test, I think if I had to wait years for the radiation to work it would have stressed me out.  But that just my take, you must make up your own mind.  If the tests confirm that your cancer is contained inside the gland then you have surgery or one of the various radiation treatments to decide on.  Do your homework, study the after effects and come to a conclusion. If you do the proper research you should not have any regrets later on, you will have made your choice based on the facts.

Dave 3+4

VascodaGama's picture
Posts: 3030
Joined: Nov 2010


I am sorry for the positive diagnosis. Six out of eight indicates a voluminous case and the Gleason grade 4 refers to an aggressive type in need of an aggressive approach. The MRI doesn't show spread but this sort of exam only verifies deformations. I think that you should pursue a PET examination (68Ga-PSMA) that checks at celular levels therefore more precise in terms of identifying the location of the cancerous cells. You could then decide on a therapy. Any one you chose involves risks and side effects which doubles the consequences if two therapies are to be done.

Your young age will take most doctors to suggest you having any treatment but young people with long expectancy of life are the ones that may lose quality living for many years. Choose wisely what to do. Do your researches on therapies and involve your family in the decision process. In any case, you should receive a clinical stage from your doctor before advancing with anything. PET would be my next approach if in your shoes.

Best wishes and luck in this journey.


Posts: 249
Joined: Dec 2017

Cleveland guy hit it on the head ..I chose the dual radiation treatment and I regret it sooo much it is literally Making me sick .....not only do I not know if it worked ..I have to take  flomax  2 Times  day in order to urinate and my bowels are a mess haven’t had a decent bowel movement in 6 months 4 out of 7 days I am passing gas every 5 minutes of the day I am a ******* mess and I don’t have a plan b if it comes back ..my quality of life is ruined ..THINK ABOUT THIS DONT MAKE THE SAME DISGUSTING GUILT RIDDEN MISTAKE I DID ..DO NOT EVEN  SEE A RADIOLOGIST THEY  CANT  BE TRUSTED...if you see a radiologist make sure you get a brosure telling you all the side effects you can expect ...and don’t let them tell you that the chance of getting a secondary cancer from radiation is like the chance of dying during the surgery ...radiologist are an full of **** they will prey on your fear of surgery like they did to me .

Georges Calvez
Posts: 295
Joined: Sep 2018

Hi Everybody,

It is fair to say that Steve has been very unlucky, some people have radiation and they recover well.
If you are lucky then you can recover from all the treatments very well and the chances are better if the cancer is small and limited.
Prostatectomy has a high risk of erectile dysfunction, even a skilled surgeon will have around 30% of fit 50 -60 year olds with no previous problems with no erectile function afterwards, other groups, older, etc will fare even worse.
90% of fit 50 - 60 year olds will recover almost total or total continence but that last ten per cent has a few that will have a lot of problems, there are treatments but they have mixed results. Older patients wil fare worse.
A lot of doctors are advocates for the treatment that they practice, you have to do your research on your case and try and make the best decision for you, it is you that will have to live with it for good or ill for the rest of your life.

Best wishes,


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