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my 3 options for treatment

Posts: 3
Joined: May 2021

Hi, I am new to this forum and appreciate all of the advice and wisdom of the threads I have been reading.

62 year old in good health.   Latest PSA in 9/2020 is 8.3.  One year previous was 7.0.  Primary care physician was concerned with velocity of results over time.  No other urinary symptoms of concern.  Had MRI (negative) and biopsy with 1/12 showing (3+4) = 7 cancer and 1 was differentiated but not cancerous.

Told my 3 options are active surveillance, radiation, or surgery.  Met with radiologist and will meet with surgeon next week.  I am reading through the pcf.org guide on the options as well, which is very helpful.  Met with a close friend who had surgery.  All 3 options have same 10 yr success I was told for my case.  My personal horizon is > 25 yrs.

Interested in resources and comments especially of others that are similar to me (good health and wondering if active survelillance is feasible for a little while or go to the surgery option and not worry at night).



VascodaGama's picture
Posts: 3356
Joined: Nov 2010

I would choose AS if the diagnosis you describe above is correct. However, before making a decision I would get  second opinions on collected data (biopsy cores and image studies).

In fact,  the PSA is well above the normal range for a 62 years old unless apart from the one positive core, hyperplasia also exists. Can you paste here the pathologist report and MRI.

Welcome to the board.

Wishing you luck in this journey. 


Posts: 17
Joined: Sep 2017

AS is certainly a great route to go (I'm on AS), if it is deemed safe.  3+4 is borderline but you have only one positive core, which is good.  It also depends upon how much of the core had cancer, and how much of that was 4.  You should probably: (1) have one or more of the genetic tests done, and (2) when going to get second opinions, make sure to ask if they consider AS safe given your specific facts.  Also, make sure to get opinions from people who specifilize in urological cancers, usually at academic medical centers.  

Posts: 3
Joined: May 2021


Thanks for your reply.  I am working with an academic medical center and did have a second opinion on the biopsy.  I am in a study that will look at the biopsy for gene expression classifier testing and I am awaiting those results.  Feeling very good about my doctors as well, all specialists in urologic cancer and care.

Posts: 688
Joined: Jun 2015



if it was me I would want a PET scan to determine if the cancer is contained to the Prostate.     3+4 is slightly on the agressive side but if the cancer is deep inside your prostate you have time to determine your course of action.  If your cancer is confined to your Prostate then surgery could be a good idea, so could radiation.  Now is the time as you have stated to do your homework on the side effects of surgery and the various radiation protocols.  I had surgery for my 3+4 in 2014 and have been undetectable ever since.  Talk to the doctors and family plus review the image data to help you make your decision.  Great doctors+ great facilities = great results.  Good luck and ask plenty of questions of this message board...........

Dave 3+4

Posts: 3
Joined: May 2021


Thanks for providing feedback - glad to hear that your surgery was very successful.  My main concern is if the cancer has spread or will soon.  The MRI that was used to guide the biopsy showed nothing distinguishable in prostate, nodes, or bones so the biopsy was a little of a surprise.  I will ask about the PET scan and what it might pick up that the MRI did not show.  I am leaning to surgery over radiation to keep radiation open if needed later.  The surgeon has a great deal of experience and is part of a large academic facility so your 'great' equation is very encoraging.

hopeful and opt...
Posts: 2326
Joined: Apr 2009

jjo really gave great advice. 
To add, a man with small amount of 3+4 is a candidate for Active Surveillance. I myself have a small amount of 3+4 and have been on active surveillance for 13 years now. I am being monitored at a major academic center, ucla. 

Posts: 688
Joined: Jun 2015

Hi Spacebar,

Gather as much info as you can to help your decision making process.  The three options you discussed are all valid, its your call, your body.  In my opinion knowing where the cancer is located inside your Prostate lets you know how much time you have before surgery or radiation needs to be a reality.  My cancer was just about ready to escape so if I would have chosen AS I might be in a bad situation today.  If your cancer is buried deep inside you could go on AS for a while until it starts to threaten escape via the Prostate wall.  Just my opinion, and you know what they say about opinions LOL..........

Dave 3+4

Posts: 159
Joined: Apr 2017

From all that I have read and heard while being on AS as a Gleason 6 since 2009, I have a personal threshold for seeking treatment.

That would be a biopsy result with two or more cores having ten or more percent of Gleason 4 pattern. 

There are many opinion/guesses as to how much Gleason 4 is too much for AS, but I think all can agree that the less, the better.


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