Keep in mind that biopsy is just a sampling and often underestimates the actual Gleason. My biopsy was 3+4 and my prostatectomy pathology a few weeks later was 4+3.
You probably heard your PSA was too high about 4-5 months ago, and presumably you are not on firmagon yet, so your cancer has exponentially gotten worse since then. For myself, with what sounds a lot like you (aggressive 3+4/4+3 Gleason, PSA at initial blood test 25, then 30 just before firmagon commencement), I did not add any delays to the run-up to firmagon and RT. My catch phrase from the DRE onward has been "suck it up buttercup."
on waiting, you can probably wait a month or two before starting treatment. Studies have shown that prostate cancer is slow growing and a small wait won’t make a difference. That said, don’t wait too long.
on treatment, at age 74, unless you are in top health shape, my guess is it’s not surgery. It’s major surgery and after 70 it’s harder to recover. Most likely, with 4+3 and possible EPE, your best option is radiation w some adt (not sure of the best length of adt). But take your time, get lots of opinions and then make an informed choice. Make sure you are not steamrolled into doing something you are not comfortable with
start studying. You are entering an extremely disfunctional industry.
After you study, and know the odds of cure for every treatment pathway, you might notice the urologists quoting much different numbers to you. I found that the docs would tell me it was my choice which way we would go, but then they would quote inaccurate statistics that if followed, would drive me to their preffered pathway.
Another mistake i made was to throw one hook in the water at a time. I was sure the docs would help me. But if they don’t, you have to throw another hook in. This causes delays. Delays allow cancer to morph its dna or advance. You may throw a bunch of hooks in at the beginning. Parallel not series. Its your life.
Go here...prostatecancerfree.org/comp...Look at these three charts til you know them by heart. If you have trouble find someone to help you read them. (Hint: draw a dot on the endpoints of each elipse and draw a line through the dots. Easier to read).
So spend 4-8 weeks studying papers and books on this subject.
Agree with Tony 666. Diagnosed 2017 at 71. Radiation and adt have worked for us. So far. Diet is now organic. No booze. Lots of exercise. He is fit and fabulous. Research is key. Surgeons just wanna do surgery. 💜
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Extracapsular extension 
Transdermal Estradiol (tE2) update # 2
Risk vs rewards of allowing psa to rise high enough for a PSMA PET CT
Is my cancer castrate resistant?
What, exactly is meant by “ organ confined”?
