Finally , tests done and a consult.

[Chasbearcat999]

Gleason 3+4. PSA 8. After MRI, biopsy and PSMA (clean), . I finally met with doctor. He seemed more interested in removal. I told him that was off of the table for me. He referred me to an RO, but I have a second consult set up Friday with Univ of Cincinnati. I was confused by his explanation when I asked him about the cribform. He stated it is more aggressive than "typical" Gleason 4. I asked then why it wasn't a Gleason 5 and he really seemed stumped. I could be wrong, but I told him that I had read a lot but obviously don't have an MD, but it seems from what I have read is that when cribform and intraductal are present is when it becomes more aggressive. He honestly seemed confused by the question, so maybe I was talking nonsense.

It has taken a ton of calls and emails, but Johns Hopkins does have my biopsy samples. One thing that he couldn't answer-He stated that I had a high number of positive cores. I had 5 of 15 cores positive. But it was a fusion biopsy, and 4 were taken directly from an 10mm lesion. I asked if that skewed the results, and he said no. Seems to me if they would have kept taking them only from the lesion, the percentage would be 100%. He didn't seem to follow my logic.

Anyway, he did refer me to an RO in addition to the consultation I had already scheduled. I also asked him about Cyberknife and he said that really only Gleason 6's were good candidates. That seemed to fly in the face of everything I have read. I expressed that to him, and he said "long term outcomes with 3+4 are not good with Cyberknife.

[Jordache]

I was Gleason 4 ….3+4 and 4+3 and a bit of 4+4. Cyber knife was not an option but then they did another fusion biopsy and down graded it to 4+3 and we’re willing to do it but was suspect to me and I have good insurance so I wondered if I would question my choice later on. I decide I wanted to be more aggressive in treatment so I wouldn’t regret it.

[Tall_Allen]

Can you travel to Cleveland for a meeting with Daniel Spratt at UH Seidman Cancer Center? The RO you spoke to doesn't know shit.

Cribriform only adds a little to the risk of pattern 4. Gleason patterns are different.

[1Ubspaine]

You sound like me in the early stages of my Prostate adventure. I fired my Urologist quickly as he was only interested in a quick removal. Once I got to UTSouthwestern, a teaching hospital in Dallas and visited with another Urologist and a talented unbiased R.O.-Dr. Garant(she was a very talented personable professional), I was confident to proceed with 5 radiation treatments.

Tall Allen is giving you great advice to get to Cincinnati to the best medical professionals.

[Miko710]

I'm interested in your case, as our situations are quite similar. I have Gleason 7 (4+3) and some Gleason 8, Low PSA (7.0), cribriform, perineural invasion, no lymph node spread, confined to capsule (PMSA PET scan) I just finished 5 sessions SBRT (so basically Cyberknife) here in Montreal on Monday. Dealing with some urinary burning, which I feel/hope will pass. Asides: I'm also hoping that my BPH will be better with a shrunken prostate. My RO has me on 18 months ADT (Eligard). Not many SE (yet), two months in. Occasional hot flash. But I'm being really careful with diet and exercise, calcium/Vitamin D. Getting a bone density scan (osteoporosis is a potential ADT SE). Bu I'm glad that I chose SBRT.

[Jordache in reply to Miko710]

I was on elligard for 18 months and felt with the side effects. They were tolerable and wanted to follow Dr Zelesfki protocol to the T to know that I wouldn’t have to deal with what if later on. Some may feel it was overkill but I stayed the course. Good luck!

[Miko710]

Thanks. This is reassuring. 18 months seems to be the recommended duration in many cases I had one urologist who suggested 12 months for my situation, but I'll see where I (and the science) is when I reach one year. I guess that the main concern is testosterone recovery, if and when.