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.