I have been doing this “dance” for 3 years with urologists, oncologists and radiologists.... 3 + 4 Gleason diagnosed in 2017. I have been arrogantly lectured by one pompous urologist and screamed at (Old Testament biblical style) by the cryogenic specialist urologist....after going thru 12 doctors I found one who would work with me for Active Surveillance. I started with a PSA of 4.2; it gradually spiked to 4.8, and over the passed 18 months has it gone down to 3.8 as of last week. The MRIs all come back the same (cancer has not breached the capsule)
Initial biopsy in 2017 ( with 2nd opinion from John Hopkins) came back Gleason 7 (3+4). I also had genetic testing ( PROLARIS) which gave a 7% of metastasis overnext 10 years. Good odds. My current urologist is pleased; however suggests I consider another biopsy to see what the cancer is doing. I took his comments under advisement
I need to keep “leading” in this “ dance” competition for at least another 20-25 years before I can “sit this one out” and get a few drinks at the bar👍😉
Active Surveillance will continue.
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Princeps
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What percent pattern 4 in those cores that were GS 3+4? The price you pay for AS with GS 3+4 is an mpMRI-targeted biopsy every 1-2 years. mpMRI alone is not enough.
That's low volume pattern 4, but high volume of cancer -- which is OK - just requires more surveillance than most. Have you thought about a transperineal template-guided (saturation) biopsy? That may give you confidence to stay on it, or may push you over the fence.
I would track free-PSA, if it gets below 10%, then a 4K Score test. If that's over about 20%, then a targeted biopsy. You have a lot of tx options with NO ADT if not ECE.
Good for you. Run the risks of biopsy to "see what is happening"? That is part of the formal protocol for AS. That plus imaging is the Active part. THE ODDS remain in your favor. The Swedish experience supports this, but maybe North Americans are not Swedes. "Ya pays ya' money and takes ya' choice."
I was in a similar situation about three years ago. I opted for FLA after I got a PSA reading of 6.6. My Urologist thought the PSA spike may have been due to prostatitis, which I had experienced in the past. In any event, the FLA has worked out fine so far.
If I were in your shoes, I would ask the Radiologist who did your latest MRI how far the lesion is from either nerve bundle. If you let it grow and it gets too close to the nerves, the side effects of treatment will be greater.
63 is a good age to be with DX. The equipt will be fine but it aint goin to be free.
I dont believe in watchful waiting..active surveillance. Years ago in ancient history people succumbed because they had no PSA and died in awful pain and suffering. These days they have non invasive treatment to prevent further cancer growth. Of all the cancers this one is highly treatable in early stages. The outcomes beat any cancer out there. Conventional treatments for this can be damaging. You dont want to be in that category. But you dont have to be. This cancer is very hormone sensitive and it can be that way for the life of a patient. You can take advantage of that reality or not. It can get to the point where that feature will be lost over time. It can be a crisis down the road which no one can fore tell. Doing a little now may stop a lot of happy horseshit down the road.
Check your DHT levels.If they are a little high or normal get that number down. 5 mg of finasteride daily drops PSA of 4 to 2. I did 3xADT at your level 2004. I did it for 18 months.
My PSA is now 3.18. I was a 3+4 GS. But I was 66 at the time of DX. There are natural herbal organics that behave like Finasteride but I am not sure how effective they are. I would not do another biopsy. There are other scans you can do that are good enough. Theres a product called PCSpes you could research online. Remember anything hormonal whether you take it intentional or not will change your GS in a bad way. That is why I say dont do another biopsy. The change in cell appearance is bogus but the pathologist will scare the hell out of you.
You need a real safety zone now not AS so much. If you maintain a low PSA youll be a lot happier. Its not gonna stop on its own.That is wishful thinking. The earlier you start the better off you are . Its just that you dont want to go crazy treating it. You need some minimal direction to manage the PSA. Actually you need to know you can lower it anytime you want.
Finasteride or Proscar is cheap and very effective. It lowers DHT and DHEA. It does it enough to keep your PSA lower.Be aware the Finasteride will shrink your prostate to some degree. I ve been taking it since 2004 and its part of the Leibowitz protocol of 2004. I know it works for me because I stopped taking it recently and my PSA jumped to 5 plus. In my blood report both my DHEA and DHT went up enough to alter my PSA .
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docrok; 15 year update. Rising PSA, Pet Choline Acetate Scan test results Mayo Clinic, Minnesota. 
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